Suicide is the second leading cause of death among teenagers in Canada, and the start of school is a particularly high-risk time for vulnerable youth. This week, The Globe and Mail presents a special series confronting an agonizing enigma. Amid their pain, victims' families are defying stigma and bringing the issue to light as never before. Read part two here and part three here and part four here.
A year ago today, Gary and Mindy Nelson went to work, believing that their 16-year-old son, Ben, was going to catch the school bus.
Four months earlier, the family had moved to the country from Ottawa, hoping to draw Ben away from his "dark thoughts," as he called them. Unlike his older sister, Ben wasn't a Starbucks kid; perhaps he would be happier in open spaces where he could ride his motorcycle on the dirt roads, see the stars at night and start fresh in a new school.
So they moved into a rambling farmhouse in Ashton, bought a flock of chickens and took solace on the rare days when they heard Ben whistling or saw him with his new cat, Gray, draped like a stole around his neck. They thought it was the right choice then. Now, they don't know, and never will.
On the morning of Sept. 24, 2010, Ben circled back to the house, went out to a shed beside the house and took his own life with his great-grandfather's antique gun. He didn't leave a note.
"I always think of him making that walk. What was he thinking?" Mindy says, her voice straining. "I can't conceive of it."
In Ottawa and the surrounding rural area, a shocking number of families are still trying to understand why their children made similarly terrible choices and what they could have done to prevent it. In June last year, six young people died at their own hands in small towns southwest of the capital – stoic, old-fashioned places where most parents still worry far more about kids driving home in the dark from bush parties than about problems like depression or anxiety. At least two more suicides followed last September.
The victims were mostly young men, some in their early 20s, current and former students. None of them knew each other, at least not well. This seemingly random scattering of loss points to the complexity of suicide, which is not confined to a "type" or any particular circumstances.
By the time the suicide of 14-year-old Daron Richardson, the daughter of Ottawa Senators assistant coach Luke Richardson, made headlines in November, communities were scrambling to prevent more deaths, without really knowing how.
Teenage suicide remains a maddening enigma. Though rates in Canada have declined since the early 1980s, it is still the second-leading cause of death among teenagers, after car accidents. Numbers are small; in 2007, the most recent year with available data, there were 218 suicides of people between 10 and 19. But the idea that even the smallest percentage of teens could feel so hopeless and bereft makes families fear what their own children may be concealing, holed up in their bedrooms with Facebook.
The start and end of school years may be particularly vulnerable times for at-risk youth, some studies say. Just this week, in Mississauga, a 16-year-old boy killed his best friend, in an apparent act of unrequited love, and then jumped off an overpass. Last weekend, in Buffalo, N.Y., 14-year-old Jamey Rodemeyer killed himself after years of bullying; months earlier, he had posted a video to the It Gets Better anti-bullying (and anti-suicide) website, describing the taunts he had faced. He urged listeners, "Just love yourself, and you're set." He was found dead outside his home on Sunday morning.
And then there is the story of 17-year-old Jesse Graham, who happily posed in Ray-Bans and black tie for his Grade 12 prom in Balderson, near Perth, Ont., then decided, days later, to hang himself in the dark.
According to University of Ottawa psychologist Darcy Santor, at least 91 per cent of suicide victims are suffering from some form of mental illness at the time of their deaths, though it may not have been diagnosed. The danger rises exponentially the more risk factors are present: depression, anxiety, alcohol abuse, bullying, social isolation, learning disabilities and often, at the root, shame. But even more so than adults, adolescents with mental illness face long waiting lists, a shortage of psychiatric beds and are often misdiagnosed.
After all, what teenager doesn't slam doors and keep secrets, sleep too much or too little, fail tests, and suffer meanness or heartbreak? Large numbers of high-school students also say in surveys that they ruminate, however fleetingly, about suicide. So what makes the few who do take their own lives so different, and how might they be found, and saved? If society could figure this out, the benefits would be vast, for every teenager who has teetered on the edge and the families they would leave behind.
As a vital starting point, some survivors are coming out and talking about it – Daron Richardson's father and her mother, Stephanie, went public immediately after her death. They and several other families also willingly shared their experiences and reflections with The Globe and Mail. In the face of the stigma that has surrounded suicide from the days when it was classed as a criminal offence, families are beginning to defy the long-held fear that simply saying the word will cause more deaths to occur, like a cough spreading a cold.
In Carleton Place, Ont., this month, a fundraising run was held in the name of a teenage suicide victim named Brett Pearson, who died in 2006, and a band played in a field outside the high school afterward so people could linger – an event hard to imagine even five years ago.
"We're not going to sit in silence," said Jesse Graham's mom, Shelly, who joined the run. "That's why kids are dying."
Out of the blue?
"When the music's over, turn off the lights," 17-year-old Jesse wrote in the early morning of June 18, 2010, quoting Jim Morrison in the note he left for his parents to find in his bedroom. "They say that high school is the best time of your life," he continued. "Well, high school is over. My music is done. … I've lived my life to the fullest."
The next morning, his father, Jeff, noticed the lights on in the basement where Jesse slept, and found his son hanging from a beam in the ceiling.
The family was stunned. They knew Jesse had been going through some issues the past year, switching friends, drinking more heavily and doing drugs. His grades were sliding. In a family of six kids, the Grahams had already raised three other teenagers, creating the kind of home where kids' friends turn up randomly at dinner time. They assumed Jesse was testing boundaries, lectured him on grades and gave him some space.
Earlier that spring, he had suggested to his mom that he might have attention deficit disorder; their doctor prescribed him a drug similar to Ritalin, which seemed to help with his concentration. But as for real warning signs? According to his parents and his older sister, Kelsie, there weren't any.
Jesse was by all accounts funny and smart, a drama-club kid with a protective circle of long-term friends. He had been bugging his dad for the truck so that he could take a girl on a date that Sunday. He spent his last night with an old friend from his church youth group, Derek. On the way home, they bought six discount movies at a video store. The two of them went down to the basement; after Derek left around midnight, declining an offer to stay over, Jesse stayed up, drinking and texting, alone.
Along with individual mental illness, suicides also do reflect social and cultural conditions. Patrice Corriveau, a researcher at the University of Ottawa, has been analyzing and cataloguing every suicide note left by a self-inflicted death in Quebec going back more than 100 years – a project uniquely possible in the province because a coroner's inquest is mandated for every suicide. He has found, for example, that in the late 1800s, long before "teenagers" were a recognized social category, the young people most likely to die from suicide were unwed girls who found themselves pregnant. In the 1930s, it was young men from Europe who had failed to find their fortune in the new land, or young husbands who had lost their fortunes and killed themselves out of shame.
Teenage suicide is a phenomenon of more recent and, paradoxically, more prosperous decades, coinciding with the invention of teen culture (and its inherent peer pressures), higher divorce rates and declines in religion, though researchers are careful not to blame any one cause. The rate among teenage boys is twice as high as girls, but that's largely because boys use more lethal means – girls actually attempt suicide more often.
Global suicide statistics are difficult to compare, but Canada falls in the middle of the pack – well below Finland or New Zealand, yet higher than Britain or Brazil. Suicide rates are generally higher in wealthier countries, where, researchers theorize, a failure to measure up in the midst of relative success is more devastating to the human psyche than being poor among the equally poor.
Shockingly, Canada's youth-suicide rate per capita is nearly triple that in the United States, although our youth homicide rates are much lower – facts partly explained by the high suicide rates in Canadian native communities, particularly in the North, and, respectively, the high rates of handgun violence in American inner cities.
Much of what we understand about suicide is the result of hindsight, finding what was missed only afterward, when it is too late to prevent it. These "psychological autopsies" have got us closer to understanding the population-wide risks, but not much better at identifying individuals.
In about one-quarter of the cases, the families report no signs of trouble until a psychologist goes digging, says Antoon Leenaars, a leading expert on suicide and past president of the Canadian Association for Suicide Prevention. "I spend a lot of time with families who say, 'We never saw anything.' But people simply are not taught what to look for."
A psychological autopsy of Jesse Graham, for instance, reveals a picture of a boy in trouble. After a local paper ran a photograph of Jesse's suicide note, a leading expert in dyslexia contacted the Grahams to say she believed Jesse had suffered from the reading disability, which would have compounded his frustration at school, adding another possible ingredient to his stress. (Jesse's 13-year-old brother, Jarred, has since shown signs of the same disability.) Looking back, it seems likely that what his parent saw as teenage angst was a deeper form of depression and anxiety. One close friend, Krystal, who was in Jesse's grade and lived with the Grahams for months after he died, says he often kicked himself for drinking and doing drugs, and worried he didn't have time to turn around his grades. "He thought he couldn't get back up, couldn't fix things."
Since his death, other friends have spilled a darker secret – that he had mentioned suicide on several occasions up to a year before he died, which not surprisingly is one of the strongest predictors. But as Krystal explains, "People my age don't go to adults to talk about things."
Another friend, Kevin, who was worried about Jesse's drug use, says, "How can you betray a friend's trust like that? But at the same time, when does the trust get null and void by the seriousness of the situation?"
Put all the pieces together, and the "typical teenager" portrait dissolves – Jesse's apparent cheerfulness starts to look forced and his rebellion becomes self-medication. The afternoon before he died, he attended the wake of an 18-year-old who had died by suicide the week before, someone he hardly knew, who had been a grade ahead of him at school. Krystal passed Jesse on the steps, and thought it odd that he was there: "He looked so sad." But the place was packed with students and not all of them had been close to the victim either.
The research on what's called contagion – the idea that one suicide can be a form of "permission giving" to others – is ambiguous, and certainly too broad to pinpoint individuals at risk. Grieving friends experience first-hand the devastation that suicide causes, which is believed to be a deterrent. However, people who are susceptible to contagion may identify with the suicide victim from a distance – and teenagers, more likely to be influenced within a peer group, would be particularly vulnerable.
Even if Jesse's decision to attend the wake had alarmed his family, though, his behaviour afterward would have reassured them. His co-workers at McDonald's said he seemed down, in hindsight, but he had made weekend plans – to spend time with Derek, to watch those movies, to go on that Sunday date.
That's part of why his sister Kelsie believes that his suicide was a rash decision, made after a few drinks, without considering the consequences. "My brother did something really stupid," she says. "He didn't think it through."
Indeed, while mental illness sets a teenager on the track for suicide, the act itself is often highly impulsive. In 2001, researchers in Houston interviewed 153 young people 15 to 24 years old who had survived a serious suicide attempt. They were asked to estimate the amount of time between when they had decided they wanted to die and when they actually attempted it. In 70 per cent of the cases, the time was less than an hour. In 25 per cent, it was barely five minutes.
For Jesse, it's impossible to know. But perhaps he hoped someone would stop him. That night, he posted a "goodbye" message on Facebook for anyone to read. And not long after Derek arrived home, he received a strange text: "Will you be my pola bearer?" Only later would he realize that Jesse had misspelled "pallbearer."
Asleep, Derek missed a second message, found on his phone when the police knocked on his door the next morning: "You've always been a good great friend. Goodbye."
Nowhere to turn
Not knowing is one thing. But what happens when you suspect a problem but can't get help?
Another one of the June, 2010, wave of suicide victims was 16-year-old Kyle Leron-McCready, who jumped off an overpass not far from his grandmother's house in Orleans, a suburb east of Ottawa. He didn't leave a note, but the trigger for his family is no mystery: That morning, a teacher had called his house and told his grandmother, Althea House, that he had failed two exams. Ms. House passed the message on to Kyle, a decision she now regrets. She was on the phone looking for him when the police arrived.
Kyle's family had known something wasn't right: His grades were slipping, he never brought any friends home and he slept all the time. When he played on his hockey team, he sat by himself and left immediately after every game, never wanting to socialize.
Kyle's mother, Samantha, was living in Toronto at the time. When he lived there, Kyle had started refusing to go to school or get out of bed. "At first it was frustrating," she says, "then frightening." She sought help from mental-health services, but finally decided to let him move back to the capital, where his grandmother and father lived.
In Ottawa, Ms. House says she raised concerns with the school and with her family doctor, but nobody wanted to call it depression. Her suggestion that he might need medication – often a controversial course for adolescents – was rebuffed.
"You can't blame it on anyone," Kyle's grandmother says. "But the people who should know don't have the knowledge." Even she, a public-health nurse, wasn't thinking about suicide. "I was worried about him losing another semester of school."
When she was finally able to get him into see the school psychologist a few weeks before he died, she was told that "there were no immediate concerns."
But maybe, she says, no one was listening closely enough, seeing Kyle simply as a behaviour problem, an indifferent student who would put on his earphones during class. In the white noise of his bad attitude and lacklustre school record, was something missed? As she learned from her days in palliative care, Ms. House says, "pain is what the patient says it is, not what I think it should be."
But she adds, carefully, "Nobody did anything malicious. People just didn't know."
The Nelsons, on the other hand, already had known they had demons to chase: Ben had tried to commit suicide before, in January, 2010, skipping school and chugging cough syrup by the train tracks near their west-side Ottawa neighbourhood; he had thrown up after the first bottle, and later confessed what he had done to his parents. They found him a psychiatrist, who put him on an antidepressant. They relaxed on school, especially the math that gave him so much trouble. Even when they found pot in his room, they let it slide.
"You feel like you are walking on eggshells all the time," says Mindy.
At the farm he appeared to be getting better, and when school began he found new friends. But at home he didn't talk much about his feelings. "You didn't get a lot of echo from him most of the time," Gary says. You had the feeling, he says, that Ben "had bricks piled on top of him."
His parent felt helpless, trying to buoy him up with shawarma dinners and movie nights at home, and not to leave him alone for very long. They hesitated about sharing the full story with his new school (although they did give some details) – they didn't want to violate Ben's confidence, and weren't sure how the information would be handled.
"I feel we were working in the dark, stumbling around," Mindy says.
In a journal started after Ben's death, Gary calculated the number of days he had with his only son: 6,007. Not nearly enough.
Rebuilding and reaching out "I forgive you that you didn't tell me you were in such pain," Shelly Graham wrote recently in a letter to her lost son. "Please forgive me for not hearing."
And yet, it seems, more and more people are listening. In Lanark County, committees have been struck to try to build a plan for prevention and intervention. With every family that comes forward, another one is inspired to do the same. Across the country, Facebook memorial pages remain alive with birthday wishes and memories, months and years later, suggesting a fledgling vehicle for a real discussion.
What's more, the families are reaching out to their children's peers – on Kyle Leron-McCready's birthday, his mother went to Ottawa and invited a few of his friends; they spent hours talking in his bedroom, where his last load of laundry still sits unfolded on the floor, and his hockey trophies stand on the shelves.
Going even further, after opening the Grahams' home to Jesse's heartbroken friends, Shelly is taking a course so that she can run a program on grief for youth.
"I had no idea, the hopelessness that's out there," she says. "And kids telling me they had suicidal thoughts. They don't know how to deal with loss and disappointment."
Finally, today at the Nelsons' place in Ashton, on the anniversary of their son's death, they are hosting a party, inviting Ben's friends out to the farm. Maybe they will share some of his secrets, or a few of their own.
"I hope they tell me something I didn't know about Ben," Mindy confesses. "I want to know him better."