S1E3 / Academic & Social Pressure / Denise Pope

How do new stressors contribute to the risk of suicide among young people?

Note: This season of American Diagnosis was originally published under the title In Sickness & In Health. 

This podcast was created by Just Human Productions. We’re powered and distributed by Simplecast. We’re supported, in part, by listeners like you.

Celine Gounder: This is “In Sickness and in Health.” I’m Dr. Celine Gounder.

In this episode, we’re going to talk about topics that some parents may find unsuitable for young children. Parental discretion is advised.

Kristine Bernardoni: We had three in three months… from the same school… Two seniors, my son was a junior.

Celine Gounder: This is Kristine Bernardoni. Her son Trevor died by suicide in November 2016.

Kristine Bernardoni: I had gotten the message that another child had died…and they believed it to be by suicide. …  There was something inside me that just infuriated me. It like ripped me open. … And at that point, I was like, what in the world, there’s three from the same school? What is happening? What is happening that these kids don’t feel like they matter?

Celine Gounder: It’s important to understand that no one risk factor… or even combination of risk factors predicts with certainty who will or won’t attempt suicide. It’s not because you’re a young trans person or because your sibling died by suicide that you will too.  So many factors have been associated with increased risk of suicide: a personal or family history of mental health problems or alcohol or drug abuse, impulsivity, having witnessed or experienced interpersonal violence, experiencing physical or sexual abuse, or sexual assault, or family dysfunction and discord, or being adopted or in the foster system, or moving around a lot, or having access to a firearm. And when it’s an adolescent suicide, the situation is even more complicated. It’s a time in our lives that comes with plenty of natural stressors, like a rapidly changing body and risk-friendly brain chemistry.

This probably won’t come as a surprise to you. None of this is new.  But there are some new players in the mix…

Here, again, is Kristine:

Kristine Bernardoni: I think that the expectations in general from the school like on homework and especially on the student athlete… it’s an incredible amount of pressure. You must act right, look right, talk right, represent right.

Celine Gounder: Social and academic pressures are different — on a different order of magnitude — for young people these days than they were in generations past. These pressures are contributing to depression, anxiety and suicidal ideation. But parents and teachers don’t always recognize the difference between hormonal moodiness and a kid in crisis, and even when they do, don’t always know how to help.

In this episode, we’re going to take a look at these newly extreme factors that many young people face on a daily basis.

It wasn’t that long ago that higher education was a sort of extra mile. A college degree might help you make more money or develop skills for a particular career, but it wasn’t a necessity. You could choose not to go, and still manage to live a comfortable, successful life. But on-the-job experience doesn’t seem to be valued as much anymore. There’s the sense that a college degree is the new high school diploma. It’s thought that most kids should look at college as a given, and at high school as the proving grounds for a prestigious university. And what about those for whom that’s not an option, who are getting left behind?

It isn’t as though adults are unaware of the academic pressures on young people. Often, they’re creating much of that pressure. They feel insecure and uneasy about their own jobs and financial security and retirement. They transmit that malaise to their kids, and in their well-intentioned attempts to prepare their kids for the future. They may not always see what their kids need in the present.

Kristine Bernardoni: We didn’t let grades go by the wayside, cause that was the future. So one of my regrets is that I didn’t do right now. Teens, it’s important to do right now. They’ll figure out their future. Unfortunately,  once you’ve lost one, it becomes very clear on what that child needed. You know, like, all the time.

Celine Gounder: Kristine Bernardoni is a nurse and mother of two living in Fresno, California. Her daughter, Kylie, is 20. A very successful student who attends UC Irvine. Kristine’s son, Trevor, passed away last year. He was one of three students from his high school to die by suicide in 2016.

Kristine Bernardoni: He was 16 years-old when he passed. Vibrant, loving. Played football.

Celine Gounder: Trevor’s death was part of a suicide cluster that shook Fresno County that year. We spoke about suicide contagion in our first episode. Each of these kids who died had completely different stories… came from different backgrounds… different families… and had different hobbies and troubles. There were some deaths that were complete shocks… others where the teens had thought of suicide or experienced depression in the past. The unifier was a connection to Clovis West High School. But Kristine doesn’t blame the school.

Kristine Bernardoni: I go to work every day, but you don’t feel what the 16 year-old feels. Looking back, he did that for 11 months out of the year. There wasn’t a downtime.

Celine Gounder: There are a handful of factors that played, or could have played, into Trevor’s decision to end his life. But what Kristine knows for sure is that leading up to his death, he’d been living an incredibly stressful life.

Kristine Bernardoni: You think that you’re going to prepare them and you’ll just get through today, cause that will – automatic – it’s not automatic. I kept pushing Trev for his brain. He was carrying 3 AP classes, he had a 91% in chemistry, he was an 86% in AP comp, an 84% in US history. And overall, he was probably, I don’t know. I haven’t seen his final grades, but I’m guessing around a 3.6 and he thought he was failing. He thought it was this real dumb kid and he just couldn’t hold the mark.

Celine Gounder: Trevor arrived at school around 6:30 AM every day, for a morning workout. Then, after classes, he’d go to football practice. He’d be home at 7:30, and then it was on to homework and chores. Weekends were busy with essays and projects. In the off season, there were the sports he had to play to stay in shape. During the summer, his days were filled with preparation for the next football season.

Kristine Bernardoni: His brain never had enough time. So when he would come to me, he would be in tears and he would say, Mom, I can’t do it, these classes are too hard, I can’t do it.  And as a mom, not recognizing the pressures of everything else he had going on that I see now, I heard him saying he wasn’t smart enough. You ask me, why didn’t he think he was good enough. That’s not what he was saying. He was saying, mom. I’m mentally exhausted.

Celine Gounder: Kristine misunderstood her son’s stress. Because academic success was at top of mind for her, she assumed that her son’s worries were based in self-doubt. She knew that Trevor had some anxiety and impulse issues — he could get really angry, really quickly. Sometimes punch a hole in the wall. But… that’s why he was going to therapy once a week.

Kristine Bernardoni: We’re just trying to figure this kid out. He would like, lie, impulsively, we weren’t sure if it was like a normal teenage kid or what was happening to us. Man, I’m a mom who was just trying to get this kid some relief.

Celine Gounder: Kristine took other measures, too. Trevor was a generally positive kid, but she made a point of discussing self-harm with him, specifically suicide.

As an ER nurse, Kristine had seen suicidal kids. She’d also seen a suicide: a 12 year-old boy. The experience so affected her that she spoke to Trevor about it shortly after.

Kristine Bernardoni: And I went to him and I said, you ever have thoughts like this? No. Have you ever wanted to hurt yourself? No. Have you ever thought about yourself not being on Earth. He says, well, briefly, like, wonder what it would be like, but I don’t want to do anything like that, I don’t want to hurt myself. You know, I wonder, like, if I wasn’t here, would things be different? And I said, don’t ever do that to me. Please. Don’t ever let me find you. I saw that mother. I heard it, I saw the pain, do not ever do it. Life is not that bad. Say something. Come to me. This boy, he knew.

Celine Gounder: So her son was aware — hyper aware, actually. Kristine says that after his death, four students separately approached her and credited Trevor with bringing them back from the brink when they were suicidal.

Aside from educating him, checking in with him and taking him to therapy every week, Kristine made sort of a unique choice for her son. Given his workload, and a diagnosis of mild attention deficit disorder, Trevor had a basic flip phone. It couldn’t handle apps like Facebook or Instagram. Kristine figured less distraction was best.

The day that Trevor died, he got a ride home with his best friend’s mom.

Kristine Bernardoni: And I called her a couple days after Trev died, and I said, did I miss it, what did I miss? Cause you feel like you must’ve been able to see it coming. She said, no, Kristine, I’m racking my brain. He skipped to the car, he asked her, hey, can I get a ride? She said she kind of just waived her hand, like, of course, get in. They joked the whole way there, to the house, we don’t live that far, maybe a mile and a half. Trev gets out of the car and Harmon says, Hey, Dude, I’ll see you around, and Trev, imagine, this big lanky kid, k? Cause he’s got these long arms and he wraps his arms around and he turns back toward the car from the house and he says, what’re you talking about dude? I’ll see you tomorrow. That was at 3:10. He was dead at 5:00.

Celine Gounder: I won’t go into the details of how Trevor died. The how isn’t the point. The point is that he’s gone, and could still be here with Kristine, with his sister Kylie, his friend Harmon, with us.

We’ll never know all the whys. There’s never just one. We do know that Trevor was living in a climate of extreme stress, and Kristine was unaware that he’d had thoughts of suicide. Even Trevor’s therapist was shocked by his suicide. The football coaches with whom Trevor ate lunch every day had no idea he was doing so poorly. His best friends were kept in the dark, too.

Kristine has been active at Clovis West since her son’s death, especially after the third suicide, when she began showing up on campus with encouraging signs, telling kids they had value, and encouraging them to speak up, always. There’s such an emphasis at the school, Kristine says, on academic preparation and sports. If there were equal emphasis on preparation for difficult life events, she thinks lives could be saved.

Kristine Bernardoni: So that when a Trevor situation comes up and he gets mad or provoked, that it doesn’t end in death. When that girlfriend breaks up with you, or you lose that game, or you’re hurt and you can’t play anymore, let’s prepare you for life so you already know what’s coming at you.

Celine Gounder: Knowing how to identify crisis, and act on it. It’s a skill that could save lives across the board… whether it’s by a concerned friend, a parent, or the kid who feels like he can’t handle the pressure. But there’s something more that Kristine comes back to again and again.

Kristine Bernardoni: I think that we’re pushing them too hard. I think that they don’t get any breaks. In my son’s case, he didn’t get a break. He didn’t get time to be a kid.

Celine Gounder: Life gets hard for everybody. But maybe we’re making life unreasonably hard for kids. Maybe we need to take more time to give them a break and to teach them skills they need to cope with life’s inevitable disappointments.

Sarah Molina: I think everyone’s afraid. We’re all fearful for what the future has in store for all of us. We look at society today and we see the way that we are. We look at whoever our role model is, and we either want to be them, or we want to be better than them.

Celine Gounder: This is Sarah Molina. She’s sixteen, and a junior in high school.

Sarah Molina: And, school-wise, we’re afraid that wherever we stand now in school is what we’re going to be like when we get older. We have so much pressure and so much fear in what our life has in for us. It starts in high school. Everyone tells us, “Oh yes, this is determining where you want to be when you get older.” Or, for example, “Your SAT score is what’s going to determine the  college that you’ll go to, and determining the college that you’ll go to is where you’re going to be when you get older.”

Celine Gounder: When Sarah was younger, she didn’t feel like she had to define herself. She was bright, happy, open. She loved traveling with her family and felt comfortable with her appearance and her clothing. But something shifted in the seventh grade. And it happened pretty quickly.

Sarah Molina: At one point, when I came back from a trip from Spain, I’d lost all of that because I was so involved with, like, “Oh my gosh. Who has this? Who has that? I should get this. I should get that.” Me just trying to fit in is where I became a different person.

Celine Gounder: Sarah says she’d always had a tendency to get into her own head. But suddenly… that became all she knew how to do. That fear… that her grades and her status were an indication of who she was and would become as a person… weighed heavily on Sarah.

Suddenly, whenever she walked into a classroom, Sarah felt like she was being judged. The other kids, she says, were materialistic. They didn’t seem to care about anything but things and stuff. And Sarah didn’t wear the clothes that everyone else wore. After a while, she started to fear she was an outsider in more ways than one.

Sarah Molina: Me comparing myself to others and trying to see who’s better, and I just tried so many things to help myself. It was just always me comparing who was better than me. Who had this, who had that. And who had the better grades. And the kids around me, I didn’t feel as if I was welcomed.

So many things piled up at once, and I was trying to be successful at school and it was hard. I didn’t care. I was just … I was lost. I was lost.

Celine Gounder: Sarah means this literally. Whoever she had been before this pressure started to build, she didn’t think that person existed anymore. And this mix of pain and self-loathing resulted in a kind of self-altering that put her life at risk. There didn’t seem to be an obvious solution in the world where she lived. Sarah calls these moments, this person who she became, “The Monster.” Like something that took over, something that she didn’t have any control over or say in.

Sarah Molina: I did have a lot of suicidal thoughts at a point. I felt unappreciated and I didn’t think I was going to get through anything because I felt so much guilt. So much was going on at this certain point. I’d given up on everything. I’d given up on school, I’d given up on friends, I’d given up on my own family, my parents. I developed this phase where I became anorexic for a certain amount of time. And I did cut myself for a moment because I… I … It was just. I’m sorry…

Celine Gounder: Sarah says that she just stopped feeling or wanting anything. Food was disgusting to her. Her family and friends stopped mattering. School stopped mattering, and she began to struggle academically. Sarah’s depression was paralyzing. It caused her to turn away from others who could help.

Sarah Molina: When you go through that stage, you’re afraid to say anything to anyone. You feel so alone, and it’s not even a situation where you do have people around you. During the moment, you feel so alone and you don’t want to say anything because you’re scared to be judged. You’re afraid of different responses from different people.

Celine Gounder: It took Sarah changing so dramatically for a teacher to finally notice and say something,  to tell her that she had become a different person. And hearing that, it helped Sarah break through her shell, her depression, her self-imposed isolation. It took months, but Sarah began to set herself on a different path. Now Sarah can look back on that time through a lens of health and confidence. She recognizes what it was that drove her in those years of self-doubt and depression. And she understands why it can happen to other kids, too.

Sarah Molina: Everyone’s so scared because we want to be good. We want to do good, and some of us have just given up on that. With those kids, they don’t seem to care about anything because wherever we stand in our society and the group of friends we have or who we talk to and this and that, and education-wise, everyone’s afraid of failure.

Celine Gounder: Sarah says that failure, for an adult, means a real kind of loss. Losing who you were before and ending up someone else. But kids haven’t become that person yet. They fear losing something that they haven’t even achieved yet. They fear losing some vague, nebulous sense of their future self, their future success.

Young people seem to have developed a standard of measure that is both powerfully motivating and deeply destructive. Sarah was given a chance to look inside herself, instead of to her peers or societal expectations, for a sense of self-worth. But many kids don’t get that second look in the hallway from an observant teacher. How is it that reasonable, well-meaning adults everywhere are not just missing this fear, but making it worse?

Celine Gounder: I spoke with someone who has spent a lot of time studying this problem, who’s seen the negative effects of undue pressure in a lot of teenagers. For Dr. Denise Pope, there’s a lot of data and evidence supporting that our young people are in crisis, caught up in an academic arms race.

Denise Pope: We talk about it in terms of root causes, so. Parental expectations. Right? We are expecting you to get good grades, get into college, persist in college, get a job. Right?

Celine Gounder: Dr. Pope is a senior lecturer at the Stanford Graduate School of Education. A few years ago, she spent some time with students at a prep school. These students were successfully taking the steps to get into a good college, live a good life. But something was off.

Denise Pope: I shadowed high-achieving kids at a high-achieving high school, and found that, even though they were high-achieving and got really good grades, they were cheating, they had mental health issues, they had ulcers, and they weren’t really engaged in learning.

Celine Gounder: Dr. Pope says that, over the course of surveying schools across the country, she and her team discovered that more than 70-percent of kids report being stressed often or always about their academics, and not in some general or self-driven way, but because academic performance is so intertwined with their sense of self-worth and how they think of themselves. And no matter how intelligent or mature, a young person’s frame of reference is limited by his or her life experience. A bad grade or a blemish on a report card can feel catastrophic, when in the big picture, it’s a minor, temporary setback. But when they internalize these disappointments as big failures, they experience this as depression or anxiety or guilt or hopelessness or worthlessness. And if young people think academics are their parents’ and teachers’ main concern, it makes sense that they might not complain to adults about the negative side effects of academic pressures. But those side effects can be pretty severe.

Denise Pope: So, if you feel like you can’t meet your parents’ expectation, you are more likely to cheat, you are more likely to feel stress. You are more likely to score very high on what we call our worry scale. You are more likely to say that you have ulcers or stomach aches, headaches or difficulty sleeping. Or panic attacks.

Celine Gounder: Sure, they might stay up all night studying, but if they get the “A,” then it was worth it, right? Besides, how much sleep does a teenager need?

Denise Pope: Parents are shocked to find out that kids, thirteen years-old and up, need to get between eight and ten hours of sleep every night.

Celine Gounder: Add to those academic pressures the extracurricular activities kids feel they need on their applications to get into college. Today’s kids are overscheduled and overextended.

Denise Pope: There’s a bilateral relationship between sleep deprivation and depression. When you’re depressed, you have difficulty sleeping, you know, you’re worried, we’ve always known that there’s been a one-way relationship. We now know that it’s a bilateral relationship. That sleep deprivation is actually connected to depression.

Denise Pope: Think about that for a moment. We know that adolescents are a demographic dealing with consistent change and adaptation, a lot of confusion, a lot of experimentation. Add to that a highly stressful work environment, and then remove sleep. Sleep deprivation compounds the pressures they feel. That isn’t exactly a formula for well-being.

Denise Pope: You think, oh, my gosh, I’m staying up so late, getting to do all this work so that I can get the grades, so I can get into college. And in fact, they’re actually hurting their short-term memory and their long term memory. There are more accidents due to drowsy driving for teenagers than drunk driving for teenagers right now. We see weight gain due to sleep deprivation. We see more bullying, because you’re not sending the messages to the part of the brain that allows you to kind of calm yourself down and think things through.

Celine Gounder: So all of these typical adolescent problem areas — body image, bullying, even car accidents — have some connection to sleep. Which isn’t to say that 8 hours a night will alleviate schoolyard bullying. But it certainly couldn’t hurt.

Unsurprisingly, Dr. Pope ran into high levels of anxiety and depression among the students she shadowed. And after years of this research, she decided to launch a campaign to help change unhealthy school environments. That’s something we’ll return to in our next episode. But there’s one more element of Dr. Pope’s research that I want to focus on now. One that has nothing to do with academics. It’s relatively new, and it’s playing a major role in modern adolescent stress.

Denise Pope: We have social media as putting enormous pressure on kids to be popular, to fit in. It used to be that you didn’t know that you weren’t invited to a party. Now you see the pictures of a party, with all your friends there, that you weren’t invited to.

Celine Gounder: Social media can leave young people feeling that much more ostracized. Plus, teens are far less likely to post on social media about the embarrassing, painful stuff than about what makes them look good to their peers. They filter reality and perform for others. And this gives their peers a false idea of what their lives should look like. The teen brain is highly attuned to what other teens think and to status. When they internalize those standards and their failure to live up to them, at least in their minds, they may come to believe they are quite literally losers.

And the potentials for social pressures are multiplied and amplified, instantly, on social media. Though cyberbullying may be old news at this point, it’s still happening every day and playing an insidious role in a lot of kids’ lives. But cyberbullying invites a lot more kids into the fold. Things can escalate really quickly, and in an environment that’s often invisible to parents and teachers.

Even the happiest, most socially adjusted adolescent — someone who manages all of those academic stressors, someone who knows how to reach out for help — can hit a downward spiral in the right toxic environment.

That’s what happened to Brandaly.

Brandaly Mora: Okay. I’m Brandly Mora. I’m a Freshman at Cooper City High School, I’m fourteen years old.

CG: Brandaly is a communicative, thoughtful, successful teenager.

Brandaly Mora: I’ve always been an honor student, always getting pretty good grades, I have A’s and B’s, GPA is pretty high. I’ve never had an F or a D.

Celine Gounder: She was born in Costa Rica, but has lived most of her life in the States with her mom, dad and brother. Brandaly’s family is really involved in her life, especially her academic life.

Brandaly Mora: Do you have homework, do you have this, do you have that – if they know about a project, they’ll be like, let me see your project, how’s it going, do you need help? In my progress reports, when they come in, the first day, they get a phone call, so, they ask, how’s your grades, what can we do to get this B to an A? What do you need to get them a little bit higher?

Celine Gounder:  So school plays a really important role in Brandaly’s relationship with her parents, but she actually has a positive take on it. She never feels like she’ll get in trouble for grades or anything like that. Her mom, she says, might get concerned if she sees a “C.” But they work together to keep her grades up, and Brandaly doesn’t seem overwhelmed.

And this is how she introduces herself, how she defines herself. As a good student with a good family. But there are things about Brandaly that have shifted drastically in the past few years. Because she also used to be a real extrovert. A few years ago, she would be out of the house all of the time. She describes herself as having been constantly surrounded by people. Now, Brandaly has a handful of close friends and a different idea of who to trust. Something happened in middle school that, as Brandaly says, changed everything.

Brandaly Mora: In 7th grade, I had a problem with this girl, because she… like, she had a boyfriend. And I — he was like — we also used to talk. And so she would kind of blame me for her problems.

Celine Gounder: Okay, so this kind of thing has probably been going on since time immemorial. Raging hormones inevitably lead to some insecurities, jealousies, fights. It’s been the way of the world for a long time. What happened next, however, is pretty new to the game.

Brandaly Mora: And she started this Instagram account saying that I was not supporting them two and I was supposedly causing them problems.

Celine Gounder: This account, Brandaly tells me, got about a hundred followers. All of them schoolmates of hers. All of them leaving comments.

Brandaly Mora: Oh my God, she’s… um. Bad words. Like, they were saying that I was the cause of all their problems and everything. And it just got to the point where everybody was saying they were going to jump me. And everybody pretty much at my school hated me because this girl made the account saying that I didn’t support her and her boyfriend.

Celine Gounder: People who Brandaly trusted and considered friends suddenly turned on her. And everyone who stuck by her?

Brandaly Mora: They were like, hey, I really don’t want you to come to school because a lot of people are saying that they’re going to jump you. You are gonna get hurt, I don’t want this to happen to you. So, it just got to the point where I didn’t even want to go to school, and I told my mom, I don’t wanna go, I don’t wanna go. And in the end, they didn’t just me, but there was a lot of understanding going around that they were going to.

Brandaly Mora: Here’s a major disconnect between the adult world and the world of teenagers. Threats of physical harm would probably be addressed swiftly and with threats of legal action in the workplace, for example. But in middle school, Brandaly was the one to get in trouble.

Brandaly Mora: Somebody came to my school counselor at the time and kind of told them their point of view, and that girl, or guy, I’m guessing, is friends with the girl that was saying that I wanted her boyfriend or whatever. So she told everything in her point of view and I got in trouble. Cause I wasn’t doing anything to help myself, or whatever.

Celine Gounder: Brandaly speaks about it casually now, but she’s describing some serious injustice here. While she admits that the school didn’t handle the situation very well, for her it boils down to the fact that she didn’t, in the end, get jumped. She was unharmed, for all intents and purposes. But this experience changed everything.

Brandaly Mora: Around that time I was just, like, staying up really, really, late. As soon as I got home, I would go to sleep and then I would wake up really late at night and just stay up the whole night and then go to school and do the whole thing all over again. Of course, it worried my parents, the fact that I would just go home and go straight to sleep, because I didn’t want to talk to anybody or do anything.

Celine Gounder: The bathroom stalls were covered in cruel comments about Brandaly’s body and appearance.

Brandaly Mora: That I was fat, and that I was ugly, and I should just kill myself. All hurtful things like that. And so, I started thinking I should just change to what society wanted me to be.

Celine Gounder: She internalized those comments. She ate less and lost weight. And it’s important to note here, while all of this was happening, Brandaly’s parents noticed. In fact, she’d gone to her mother as soon as the Instagram account was created. And she says they tried to help, to be involved in whatever was going on with their daughter. But Brandaly says that they just didn’t understand. They hadn’t gone through anything like that themselves. So, despite their efforts, they didn’t know how to help her.

Brandaly Mora: They just thought that I needed some time to get over the fact that all of these problems were happening, and they didn’t really know how to make it better. So, when I was alone, I would always be wearing a sweater, no matter what. I would be like, oh, my God, I’m so cold. And my parents would – of course, they would never think that I was doing something like that.

Celine Gounder: Brandaly couldn’t separate who she was from the trauma of the bullying. It didn’t take long for Brandaly to look for a way to disconnect from that pain. She says she stopped caring about what happened to her. And this thing her parents would never expect their daughter to do?  Brandaly started to self-harm, cutting her arms and wrists, and hiding it under long sleeves.

Brandaly only told one friend. But eventually, her school did find out about the cutting. And that’s when they chose to spring into action, suspending Brandaly, telling her parents about what was going on, and insisting she seek psychiatric care before should could be admitted back to school.

So Brandaly started seeing a therapist at a psychiatric hospital in Miami. And, she says, that specific, clinical care? It worked.

Brandaly Mora: In the beginning I wasn’t really so sure that it was helping and I wasn’t so sure that it was doing anything, but now, looking back on it, it definitely did help me. It definitely let me let some stuff out that I couldn’t let out at home or with my friends, and I knew that I could trust my therapist, tell her anything and she wouldn’t say anything to anybody.

Celine Gounder: The thing is, Brandaly did have a support system as she was going through this trauma. Her parents tried to help her, but they hadn’t lived through this sort of thing and didn’t know how to help. Brandaly had true, clinical depression. She needed the same clinical care that almost anyone, of any age, might need during a period of self-harm and helplessness. Her school made her seek treatment… but in a way that made her feel like she was the problem.

The light at the end of the tunnel? People have noticed there’s a problem. And they’re doing something about it, including Brandaly.

These days, Brandaly is part of a club at school that teaches communication and empathy skills. It’s a group that Sarah Molina, from earlier in our episode, has found solace in as well. It is, essentially, a safe place that shows kids how to be good to one another. She knows how to recognize people who may be going through what she went through, people who don’t know how to reach out, or express their stress. And she reaches out to them.

There are bigger efforts, too. National efforts that are targeting everything from schools to social media sites. And they’re seeking to create a sustainably safe environment for young people.

We’re going to hear from those people and organizations, and learn what can be done to change the stats for our youth population. Next time, on “In Sickness and in Health.”

If someone you know is in crisis or thinking of hurting themself:

• Do not leave them alone.

• Remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt.

• Take them to an emergency room or seek help from a medical or mental health professional.

• Call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255).

• Or text the Crisis Text Line at 741-741.

• Another resource for LGBTQ youth is the Trevor Project’s Lifeline at 866-488-7386.

• Thank you for listening.

Credits: Today’s episode of “In Sickness and in Health” was produced by Hannah McCarthy and me. Our theme music is by Allan Vest.