When a youth suicide epidemic rocked the South Boston community in the late 1990s, the community put out a call for an intervention to help slow the escalating teen suicide rate. A program called Youth Centered Suicide Prevention (YCSP), developed and led by Glenn Saxe, MD, associate chief of Psychiatry at Children's Hospital Boston and the director of Children's new Center for Behavioral Science, developed the program in answer to this call.
YCSP is the first program of its kind in the country. It started in 2006 after a program development process that lasted several years, and is being piloted at Monument and Odyssey high schools in South Boston—a community still plagued with higher-than-average teen depression and suicide rates.
The YCSP model trains high school students to act as peer leaders within their schools to educate other students about depression and help them advocate for their own mental health. They meet weekly with Children's social workers Mary Kate Little, LICSW, and Melissa Vogt, LICSW, to discuss students they feel are at risk and learn ways to support them. Little and Vogt train the 15 to 20 peer leaders every Monday during the students' lunch period, covering topics like how to recognize signs of depression (like when students quit activities or give away favorite items) and teach them ways to let peers know that it's okay to ask for help. Learning these skills helps peer leaders strive toward the overall YCSP goals: raising awareness of mental health issues, preventing suicide and enhancing intervention effectiveness within the schools.
Most school-based suicide prevention programs rely on teachers and parents to recognize students who are struggling with mental health issues. However, focus groups conducted by the YCSP program showed that these are often the last people who students are willing to go to for help. This led Saxe to develop this model in which peers were trained in recognizing and supporting at-risk students and referring them to clinicians. While peer leaders deal with serious matters, Little and Vogt take care to ensure they don't handle situations alone. "We work with them so they understand they aren't therapists, but are under our guidance and support," says Saxe. "I think the peer leaders have been most successful in changing help-seeking behaviors by making it more socially acceptable for students to seek mental health related help," says Vogt. "It doesn't have the stigma that talking to a mental health counselor might have."
Andres Mejia, a sophomore at Monument high school, lives in Dorchester and is a second-year peer leader. "Since I became a peer leader I can see that when kids don't do their homework it can mean that something else is going on," he says. The YCSP program helped Mejia become a "go to" kid when someone needs help. He's known for wearing his "Don't Worry Alone" t-shirt, which Mejia says can be a good conversation starter. "A lot of kids will come up to me and ask me where I got it or what it means," he says.
Mejia joined YCSP not only to help his classmates, but also to ensure that he was headed down the right path. He grew up surrounded by gangs and violence in his former home of Lynn and found he was making some risky choices. This helped him realize most adolescents find it hard to make the right decisions alone. "When I started supporting other people, it helped me make the right decisions," he says. "The best thing I can do is to always be there for someone, and not just when they're having a problem, so they know I'm their friend and they can talk to me."
Mejia has witnessed many of the problems prevalent in his school that often result in or contribute to adolescent depression: high drop out rates, substance abuse, fighting and gang violence resulting from racial and cultural clashes. "When there's any history of violence in a young person's life, it can compound feelings of helplessness and anger," says Little. Students may not even be aware that these feelings are often the root of what is often dismissed as simply having a bad attitude.
In addition to counseling and referring students, peer leaders also organize events to promote mental health awareness. They recently hosted a talent show, interspersed with "public service announcements" to educate the audience about substance abuse, healthful relationships, suicide and depression. Mejia was able to show off his salsa dancing skills and liked the fact that it gave a wide range of students a chance to participate in something extra-curricular.
So far, the program has been successful and 15 percent of the schools' students have been referred to Little and Vogt for depression and suicide risk assessment. Mejia remembers one student who was on the verge of dropping out but, with his help, started to turn in her homework; he even helped her find a job. "I feel fortunate to be able to watch a student face a challenge, seek help, work hard and overcome the issue," says Vogt.
Saxe hopes that this model will become a national program for youth suicide prevention. "The peer leaders get a certain satisfaction for really doing something good for others and they really do emerge as leaders within the school," says Saxe. Mejia couldn't agree more. "If there weren't peer supporters, I think a lot more people would be going down the wrong path," he says. "It helps everybody. Kids know we can help them and see us as leaders."