Preventing Suicide Deaths in Tompkins: What’s Next?

The Suicide Prevention Center of New York conducted a two-hour workshop on June 29 that outlined a six-step strategic planning model to help Tompkins County identify suicide risk factors in the community and appropriate mitigation tools for addressing them.

WATCH: Suicide Prevention Workshop for Tompkins County

The workshop was conducted via Zoom by Garra Lloyd-Lester, director of the center’s Community and Coalition Initiatives, for the 19-member strategic planning work group of the Tompkins County Suicide Prevention Coalition.

“The goal of this workshop is to provide a framework, a structure, that you all might consider to then utilize going forward to develop your county’s strategic plan for suicide prevention,” said Lloyd-Lester.

He cited reports of at least 54 suicide deaths in Tompkins County from 2017 to 2021; 87 percent of those who died by suicide were white and 20 percent were in the 20-29 age bracket. Suicide is the 10th leading cause of death in the United States, and the second leading cause of death for Americans aged 10-34.

The Tompkins County Suicide Prevention Coalition was formed in 2017 to intensify suicide prevention efforts in the community; as of April 2021, the coalition listed 215 members including 73 agencies and community organizations.

READ: Click here for more information about suicide prevention in Tompkins County

Lloyd-Lester said that Step 1 in strategic planning involves compiling data to achieve the clearest possible understanding of a community’s suicide deaths—who is dying, and by what means.

“We want to talk about who in our community is dying by suicide, who in our community might be experiencing suicidal thoughts that haven’t necessarily led to actions, or experiencing suicidal thoughts that led to attempts that didn’t result in the individual dying,” said Lloyd-Lester.

“We want to be thinking about other characteristics that we might be able to gather: age, gender, race, ethnicity, and other characteristics that might help us begin to understand in our community who is dying by, or making attempts toward, suicide.”

Lloyd-Lester added that it is equally important to understand how people are making attempts or completing suicide. “Is there one or more that tends to be the more prevalent method in our community?” he asked. “Understanding how people are dying in our community and making attempts can really help to begin to explore possible interventions and strategies.”

READ: Click here for more information about the Suicide Prevention Center of New York

Step 2 recommends that the coalition consider two or three long-term goals, aimed at addressing the trends indicated by the data; the goals might focus on a demographic group reporting a higher suicide rate, or particular methods that appear to be prevalent in the community’s suicide deaths.

In Step 3, the coalition is advised to identify the key risk factors and protective factors or lack thereof in the community. Risk factors include mental health conditions, availability of lethal means such as firearms or drugs; protective factors include availability of mental health resources, social connectedness, and coping skills.

“We have to be thinking about ‘why’,” said Lloyd-Lester. “Are there any unique risk factors in the community that contribute to suicidal behaviors? It is not just enough to know the commonly understood risk factors. We need to drill down and say, ‘In our community, are there any unique risk factors that we can begin to address?’”

Lloyd-Lester said that Step 4 involves selecting practical, evidence-based interventions for decreasing a community’s risk factors and increasing protective factors. He cited examples such as packaging prescription drugs in lesser quantities to reduce their potential as a lethal means for suicide; or promoting problem-solving skills among young people as an increased protective factor. He recommended that the coalition take an inventory of suicide prevention efforts already underway that could be built upon, such as adoption of the Zero Suicide Model for healthcare providers and gatekeeper training for identifying at-risk individuals.

In Step 5, the coalition is advised to develop a plan to evaluate its efforts to prevent suicide deaths; Lloyd-Lester said an evaluation helps to track and measure progress and to show partners, stakeholders, policymakers, funders, and the community the value of suicide prevention efforts.

Finally, Lloyd-Lester said that Step 6 is the creation of an action plan to implement the suicide prevention interventions identified in Step 4. He said an action plan usually includes a list of tasks and who is responsible for them, and a timeline for implementation.

“I find that if I don’t have a timeline in place the ball can keep getting kicked down the road,” he said. “So I would suggest at least coming up with a rough timeline of when we hope to have the data presented, when we hope to have the long-term goals presented, and ultimately when we hope to have a final plan to present to the full coalition.”

Lloyd-Lester cautioned that a number of speed bumps can hinder the success of a strategic plan: unrealistic goals; lack of focus, resources, or full member commitment; developing and creating a plan for the sake of having a plan but just putting it on the shelf.

INTERESTED? To join or support the Tompkins County Suicide Prevention Coalition, contact coalition convener Sally Manning at SallyMCSS@racker.org

[If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.]

Kid in College? Read This to Know the Mental Health Risks

A letter of acceptance to college, which usually arrives in March or April before high school graduation, is a wonderful milestone for young people and their parents. Thus begins an exciting and sweet passage: commencement festivities, packing for life on a college campus, some goodbyes and hugs, moving into a dorm, making new friends, and beginning a promising academic journey into adulthood.

After more than a year of Covid-19 pandemic restrictions, the smiles will be wide when students arrive this fall for what is expected to be normal in-person classes at Cornell University, Ithaca College, and Tompkins Cortland Community College.

It is very easy to overlook—or even be clueless about—what for some students will become a dark side of leaving the family nest: anxiety, depression, sexual assault and hazing violence, misuse of alcohol and drugs, academic struggles, relationship problems, and more.

At Cornell, the proportion of undergraduates who reported that they were unable to function academically (missing classes, unable to study or complete homework) for at least a week in the past year due to depression, stress, or anxiety increased from 33 percent in 2015 to 42 percent in 2019. Many reports indicate that college students are struggling even more with their mental health during the pandemic.

College orientation materials usually provide some notice about the risks and the resources for staying safe and healthy, but they may have minimal impact amid the excitement of transitioning to college.

So, a word of advice for college students, particularly for incoming first-years:

Educate yourself about the mental health challenges that you may face, and learn about the ways that you can address those challenges if and when they arise.

The same advice goes for parents. Know what your college kid is getting into.

To help, Forefront Suicide Prevention, a center at the University of Washington, recently produced A Guide for Parents and Families: Supporting Your College Student Through Mental Health Challenges.

DOWNLOAD: A Guide for Parents and Families: Supporting Your College Student Through Mental Health Challenges

This essential booklet was written by Forefront’s Marny Lombard, who has gained a profound understanding of the challenges that college students may experience. Lombard’s son Sam struggled for many years with depression and died by suicide in 2013. He was 22 years old and a college senior majoring in architecture. Lombard wrote the Guide to provide parents and families with the knowledge that she needed but did not find.

“Mental health problems among young adults are more common than many families realize,” the Guide says. “In fact, one in three college students experiences a mental health issue, most commonly anxiety or depression. Major life changes such as adjusting to college life and experiencing added academic stress can set the stage for the onset of mental health issues.”

According to the Guide, parents and family members sometimes struggle to understand their student’s mental health concerns—or even to recognize that their student is in distress. Learning that their student is having suicidal thoughts can create extreme stress for the family.

Forefront’s Guide provides authoritative resources and recommended reading to help parents and families of students who are struggling with their mental health. It can help them to stay in touch with their students and know when and how to seek help if needed.

The Guide asks parents to gradually change the tenor of their conversations with their students, listening more and speaking less. Using compassion, setting aside judgment.

Guide sections include: “Ways to Keep Conversation Flowing”; “Ask about how things work at your college”; Finding the Right Therapist,” “What To Do When Your Student is Struggling”; “About Medications”; and “If Your Student Is Thinking About Suicide.”

“Suicidal urges, in particular, should always be taken seriously and never dismissed as a ploy to gain attention,” the Guide says, noting that “asking someone whether they are thinking about suicide will not plant the idea in their mind.” The Guide provides valuable information about engaging with a suicidal student and helping them get professional help. Suicide is preventable. “The vast majority of young people who consider suicide will move through this difficult time,” the Guide says. “Many will begin to learn how to manage their mental health.

Finally, the Guide advises parents to check in regularly about their students’ stress levels and warns against delaying treatment when the need is clear. It cites data showing that 75 percent of the time the onset of mental illness occurs by the age of 24.

“The longer the delay between the onset of mental illness and the start of treatment, the more difficult it can to successfully treat these issues,” the Guide says. “The good news is that you can learn how to support them and help them manage the underlying stressors.”

For more more resources, click here for the Student Mental Health page on The Sophie Fund Website

Take a Mental Health Test

May is Mental Health Month! Why not do a self-check to see how your mental health is doing right now? Mental Health America (MHA) provides a quick-and-easy-to-use online screening tool to test whether you are experiencing symptoms of a mental health condition. MHA says that 3 million Americans have taken a test during the Covid-19 pandemic in the past 12 months.

Click here to take MHA’s mental health tests

You can screen for anxiety, depression, postpartum depression, Post-Traumatic Stress Disorder, Bipolar Disorder, Eating Disorder, psychosis, and addiction. Parents can also take a test to understand whether their children may be experiencing emotional, attentional, or behavioral difficulties. There is also a similar test with youth-themed questions that young people can take to check on themselves.

Following screening, you will be provided with information, resources and tools to help you understand and improve your mental health.

MHA notes that online screening tools are meant to be a quick snapshot of your mental health. “If your results indicate you may be experiencing symptoms of a mental illness, consider sharing your results with someone,” MHA advises. “A mental health provider (such as a doctor or a therapist) can give you a full assessment and talk to you about options for how to feel better. Mental health conditions are real, common and treatable, and recovery is possible.”

“We at Mental Health America have witnessed an unprecedented increase in the numbers of people experiencing mental health problems,” said Paul Gionfriddo, MHA president and CEO. “In November 2020, the Centers for Disease Control and Prevention reported that 44 percent of us were dealing with either depression or anxiety. While historically data shows us that 1 in 5 adults will experience a mental health problem, these days it certainly feels like it’s 5 in 5.”

For Mental Health Month, MHA is providing a package of materials that can be used by healthcare providers, community organizations, schools, and social media users to encourage greater awareness and treatment for mental health conditions.

DOWNLOAD: MHA’s “Tools 2 Thrive” toolkit

The toolkit highlights six topcis:

Adapting After Trauma and Stress

Processing Big Changes

Getting Out of Thinking Traps

Radical Acceptance

Taking Time for Yourself

Dealing with Anger and Frustration

During Mental Health Month, follow and share The Sophie Fund’s education campaign on Instagram and Facebook to learn about screening tools, treatment methods, suicide safety plans, crisis hotlines, and mental health statistics.

The infographics relay expert information from sources such as Mental Health America, National Alliance on Mental Illness, American Foundation for Suicide Prevention, and Suicide Prevention Resource Center. The campaign was created by Margaret Kent, an Ithaca College student and intern at The Sophie Fund.

Suicide Prevention: A New “Call to Action”

U.S. Surgeon General Jerome Adams on January 19 issued a “Call to Action” report to implement the 2012 National Strategy for Suicide Prevention, a detailed roadmap for preventing suicide in a comprehensive and coordinated way. “Much remains to be done,” the report warned. “Suicide prevention continues to lack the breadth and depth of the coordinated response needed to truly make a difference in reducing suicide.”

The report noted a new urgency behind suicide prevention efforts: the COVID-19 pandemic has now created conditions that may further suicide risk, such as increased social isolation, economic stress, and reduced access to community and religious support. “Problems resulting from the pandemic—including physical illness, loss of loved ones, anxiety, depression, job loss, eviction, and increased poverty—could all contribute to suicide risk,” Adams said.

The report said that in 2019 more than 47,000 Americans died by suicide, and that the national suicide rate increased 32 percent—from 10.5 to 13.9 per 100,000 people—in the 20-year period from 1999 to 2019. The report notes that for every person who dies by suicide, thousands more experience suicidal thoughts or attempt suicide—in a 2019 survey, 1.4 million U.S. adults reported attempting suicide in the past year and 3.5 million adults reported making a suicide plan.

“Although research has identified many strategies that can be effective in preventing suicide, these evidence-informed approaches have not yet been brought to scale,” the report said. Indeed, it added, an assessment of progress toward implementation of the National Strategy showed that few efforts have been comprehensive or strong enough to have a measurable impact on reducing suicidal behavior.

[If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.]

The report highlights the Zero Suicide Model as one of the key instruments for saving lives. In 2018, the Tompkins County Suicide Prevention Coalition and the Tompkins County Legislature endorsed the model, which incorporates recommendations for “a gold standard of care for people with suicide risk.” The model stresses the need to include suicide prevention as a core component of all health care services, rather than limit it to services provided by mental health specialists, and to improve professional and clinical training and practice for preventing suicides.

The report calls for increased use of a key component of the Zero Suicide Model: a suicide safe care pathway, to ensure that patients at risk for suicide are identified and provided with continuing care tailored to their needs.

“All patients are screened on past and present suicidal behavior, and positive screens are followed by a full assessment. Individuals identified as being at increased risk are entered into a suicide safe care pathway, thus ensuring that they are provided with the attention and support they need to stay safe and recover.

“Components include periodic assessments of suicidality and ongoing follow-up, including contacting patients who fail to show up for an appointment or withdraw from care. The inclusion of family members and other identified support persons in pathway implementation may help support patient engagement.

“Implementation of a suicide safe care pathway requires that protocols and systems be in place to collect and analyze data to track services, ensure patient safety, and assess treatment outcomes. The system should collect data on process measures, such as screening rates, safety planning, and services provided; care outcomes; suicide attempts and deaths; and any other relevant factors, such as sociodemographic characteristics, clinical history, and referrals to other sources of care.

The report noted that in response to the need for a minimum standard of care for individuals at risk for suicide, the National Action Alliance for Suicide Prevention in 2018 developed Recommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe. It identifies individual recommended practices—such as screening and assessment for suicide risk, collaborative safety planning, treatment of suicidality, and the use of caring contacts—that can be adopted in outpatient mental health and substance misuse settings, emergency departments, and primary care.

Read: What Tompkins County is doing to prevent suicide deaths

The surgeon general’s Call to Action states that while that all 13 goals and 60 objectives of the 2012 National Strategy remain relevant, it is time to focus on six key actions in order to reverse the current upward trend in suicide deaths in the United States.

The Call to Action identifies four strategic directions: Healthy and Empowered Individuals, Families, and Communities; Clinical and Community Preventive Services; Treatment and Support Services; and Surveillance, Research, and Evaluation.

Within those directions, the Call to Action identifies six main actions to pursue:

Activate a broad-based public health response to suicide

Address upstream factors that impact suicide

Ensure lethal means safety

Support adoption of evidence-based care for suicide risk

Enhance crisis care and care transitions

Improve the quality, timeliness, and use of suicide-related data

Download: The Surgeon General’s Call to Action

SUMMARY OF THE CALL TO ACTION REPORT

Action 1. Activate a Broad-Based Public Health Response to Suicide: Inspire and empower everyone to play a role in suicide prevention.

1.1 Broaden perceptions of suicide, who is affected, and the many factors that can affect suicide risk.

1.2 Empower every individual and organization to play a role in suicide prevention.

1.3 Engage people with lived experience in all aspects of suicide prevention.

1.4 Use effective communications to engage diverse sectors in suicide prevention.

Action 1: Priorities for Action

  • State government and public health entities should implement the Suicide Prevention Resource Center’s Recommendations for State Suicide Prevention Infrastructure to support comprehensive (i.e., multi- component) suicide prevention in communities.
  • Prevention leaders from the public and private sectors, at all levels (national, state, tribal, and local), should align and evaluate their efforts consistent with the Centers for Disease Control and Prevention (CDC) resource Preventing Suicide: A Technical Package of Policy, Programs, and Practices, to expand the adoption of suicide prevention strategies that are based on the best available evidence.
  • Federal agencies and state, tribal, local, and county governments and coalitions should strengthen their prevention efforts by developing strategic suicide prevention plans based on available public health data. Mechanisms for the prompt sharing of innovations and best practices should be developed and supported.
  • State and local suicide prevention coalitions and health systems should actively reach out to organizations serving populations at high risk for suicide; these systems should also reach out to individuals with lived experience in order to learn from them and engage them in designing prevention efforts.
  • The public and private sectors should invest in patient-centered research and include people with lived experience in research design and implementation.
  • Federal agencies, mental health and suicide prevention non-governmental organizations, and others conducting communication efforts should ensure that suicide prevention communications campaigns (1) are strategic, (2) include clear aims for behavior changes that support broader suicide prevention efforts, and (3) measure their impact.
  • The federal government (Congress) should expand and sustain support for states, territories, communities, and tribes to implement comprehensive suicide prevention initiatives similar to the Comprehensive Suicide Prevention Program, funded by CDC, and the Garrett Lee Smith youth suicide prevention grants, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), which have been shown to reduce suicide in participating counties, particularly in rural areas. Funding targeting substance use disorder should be broad enough in scope to allow for interventions that address suicide prevention and related workforce and infrastructure needs.

Action 2. Address Upstream Factors that Impact Suicide: Focus on ways to prevent everyone from suicide.

2.1 Promote and enhance social connectedness and opportunities to contribute.

2.2 Strengthen economic supports.

2.3 Engage and support high-risk and underserved groups.

2.4 Dedicate resources to the development, implementation, and evaluation of interventions aimed at preventing suicidal behaviors.

Action 2: Priorities for Action

  • Private companies and workplaces should leverage their health care benefits purchasing power to enhance employee mental health (e.g., invest in benefits and programs to prevent and treat behavioral health problems) and work to shape worksite values and culture to promote mental health by providing access to crisis support, support to employees following a suicide, and ongoing mental health wellness programming.
  • Suicide prevention leads in federal, state, tribal, and local public health and behavioral health agencies should partner with their counterparts in labor and workforce, housing, health care, and other public assistance agencies to collaborate on strengthening economic supports for families and communities.
  • Foundations and other philanthropic organizations that support early intervention programs— particularly those targeting (1) social determinants of health (e.g., reducing poverty and exposure to trauma, improving access to good education and health care, improving health equity) and/or (2) enhanced social interactions (e.g., improved parenting skills) and problem-solving and coping skills— should ensure that these programs include outcomes related to suicide (e.g., ideation, plans, attempts) and evaluation of those programs for suicide-related outcomes.
  • Federal government and private sector research funders should support the analysis of existing data sets of longitudinal studies to determine the impact of various interventions (e.g., home visitation, preschool programs, substance misuse, child trauma) on suicidal ideation, plans, and attempts, and on deaths by suicide. This could include such projects as the CDC’s efforts to assess and prevent adverse childhood experiences and examine their effect on suicide-related problems, and National Institutes of Health (NIH) initiatives that focus on aggregating prevention trial data sets to better understand the long-term and cross-over effects of prevention interventions on mental health outcomes, including suicide risk,88 and to address suicide research gaps.

Action 3. Ensure Lethal Means Safety: Keep people safe while they are in crisis.

3.1 Empower communities to implement proven approaches.

3.2 Increase the use of lethal means safety counseling

3.3 Dedicate resources to the development, implementation, and evaluation of interventions aimed at addressing the role of lethal means safety in suicide and suicide prevention.

Action 3: Priorities for Action

  • The federal government and private sector entities can support efforts to ensure that updated information on lethal means safety policies, programs, and practices (e.g., ERPOs, firearm owner and retailer education, bridge barriers, medication packaging, carbon monoxide shut-off sensors in vehicles) is incorporated into existing national clearinghouses and resource centers so that local municipalities, states, and tribes can adopt and evaluate them for their prevention benefits.
  • States, communities, and tribes should collaborate with the private sector to increase awareness of and take action to reduce access to firearms and other lethal means of suicide, including opioids and other medications, alcohol and other substances or poisons, and community locations (e.g., railways, bridges, parking garages) where suicidal behaviors have occurred. This urgent multi-sector effort is key to saving lives by reducing access to lethal means for individuals in crisis.
  • Health systems and payers should leverage their existing training and resources and collaborate on a national initiative to train general and specialty health care providers and care teams on safety planning and lethal means counseling.
  • SAMHSA and the VA should coordinate to ensure that lethal means safety assessment and counseling are incorporated into the assessment and intervention procedures of the National Suicide Prevention Lifeline and Veterans Crisis Line call centers, particularly in preparation for the national launch of 988.
  • The federal government can prioritize and fund research and program evaluation analyzing community and clinical lethal means safety interventions (e.g., ERPOs, firearm owner and retailer education, bridge barriers, medication packaging, carbon monoxide shut-off sensors in vehicles) at the population level.
  • State and federal governments should collaborate with the private sector on a synchronized public health communication campaign addressing lethal means safety in the context of suicide prevention, which should then be evaluated to determine prevention benefits and inform future communication efforts.

Action 4. Support Adoption of Evidence-Based Care for Suicide Risk: Ensure safe and effective care for all.

4.1 Increase clinical training in evidence-based care for suicide risk.

4.2 Improve suicide risk identification in health care settings.

4.3 Conduct safety planning with all patients who screen positive for suicide risk.

4.4 Increase the use of suicide safe care pathways in health care systems for individuals at risk.

4.5 Increase the use of caring contacts in diverse settings.

Action 4: Priorities for Action

  • The federal government, professional associations, and accrediting bodies should collaborate to address barriers to adopting the Action Alliance’s Suicide Prevention and the Clinical Workforce: Guidelines for Training to ensure increased clinical training in evidence-based care for suicide risk during graduate education and post-graduate training.
  • State behavioral health licensing boards should add continuing education requirements for suicide prevention in order for clinicians to maintain licensure or certification.
  • Payers from the public and private sectors should incentivize the delivery of evidence-based care via existing levers in contracting and reimbursement.
  • Federal and state policymakers and commercial payers and health systems should take specific steps to improve outcomes for individuals with mental health and substance misuse conditions in primary care by using effective methods (e.g., CoCM) to integrate mental health and substance misuse treatment into primary care.
  • To enhance workflows for suicide safe care, health systems should collaborate with EHR vendors to develop options for integrating screening, suicide safe care pathways, and safety planning into their EHR systems.

Action 5. Enhance Crisis Care and Care Transitions: Ensure that crisis services are available to anyone, anywhere, at any time.

5.1 Increase the development and use of statewide or regional crisis service hubs.

5.2 Increase the use of mobile crisis teams.

5.3 Increase the use of crisis receiving and stabilization facilities.

5.4 Ensure safe care transitions for patients at risk.

5.5 Ensure adequate crisis infrastructure to support implementation of the national 988 number.

Action 5: Priorities for Action

  • The federal government and the private sector should address gaps, opportunities, and resource needs to achieve standardization among crisis centers in interventional approaches and quality assurance in preparation for the launch of 988.
  • The federal government, states, and the private sector should work together to optimize system design, system operations, and system financing for 988 as the hub of an enhanced, coordinated crisis system, and enhance coordination between Lifeline 988 centers and 911 centers to reduce overreliance on 911 services and ED boarding (the practice of keeping admitted patients on stretchers in hallways due to crowding).
  • The federal government should fund the necessary infrastructure to support crisis care (e.g., Congressional support for the 5 percent SAMHSA Mental Health Block Grant set-aside; core services identified in SAMHSA’s National Guidelines for Behavioral Health Crisis Care) and should provide technical assistance to states looking to evolve crisis systems of care.
  • The federal government and foundations should support research to identify effective models of mental health crisis response (e.g., coordinated efforts among mental health specialists, peers, and law enforcement) to improve short- and long-term effects on communities of color and other marginalized populations.
  • The federal government and private sector payers should support the use of follow-up phone calls or texts within 24 hours of discharge from psychiatric hospitalization or emergency room discharge to check in with the patient, provide support, and maintain contact until the person’s first outpatient appointment.
  • The federal government should establish universally recognized coding for behavioral health crisis services, and public and private sector partners should collaborate with payers and health systems to increase adoption of the new coding.
  • The federal government should support the development of an essential benefits designation that will encourage health care insurers to provide reimbursement for crisis services, thus reducing the financial burden on state and local governments to pay for those services, delivered within a structure that supports the justice system and ED diversion.

Action 6. Improve the Quality, Timeliness, and Use of Suicide-Related Data: Know who is impacted and how to best respond.

6.1 Increase access to near real-time data related to suicide.

6.2 Improve the quality of data on causes of death.

6.3 Expand the accessibility and use of existing federal data systems that include data on suicide attempts and ideation.

6.4 Improve coordination and sharing of suicide-related data across the federal, state, and local levels.

6.5 Use multiple data sources to identify groups at risk and to inform action.

Action 6: Priorities for Action

  • The federal government should support near real-time collection of data on deaths by suicide and nonfatal suicide attempts in a group of sentinel states to develop the framework for a national early warning system for suicidal behavior in the U.S. The system would create a central database that links multiple data sources and would build state and local capacity to translate data trends into prevention efforts in a timely manner. In addition, the federal government should expand ED SNSRO to monitor nonfatal suicide-related outcomes, track spikes and potential clusters in suicide attempts, and identify patterns, all of which can then inform prevention activities.
  • The public and private sectors should collaborate on a near real-time suicide dashboard that pulls data from existing national, state, tribal, and community databases to make data on deaths by suicide and suicide attempts timelier and more accessible, thus linking the dashboard to prevention actions on the ground.
  • The federal government should implement Recommendation 1.8 of the Interagency Serious Mental Illness Coordinating Committee, which calls on public and private health care systems to routinely link mortality data for serious mental illness (SMI) and serious emotional disturbance (SED) populations, and supports the standardization of similar data gathering across state and local systems for SMI and SED populations within the justice system.
  • Professional organizations connected to coroners and medical examiners at the state and national levels should release guidance on and support wide-scale implementation of coding sexual orientation and gender identity in death investigations.
  • The federal government should implement the PREVENTS Executive Order recommendation for the U.S. Department of Health and Human Services and the VA to propose legislative changes that mandate a standardized process for uniform ED data reporting across the United States specific to the external cause of injury (e.g., suicide attempt).
  • Health care systems should work with public sector agencies to support the linkage of mortality data with health record, social, geographic, education, and criminal justice data systems to strengthen data quality and increase accountability for patient outcomes across key systems.
  • State suicide prevention coordinators and community suicide prevention leaders should routinely monitor available data to identify trends and evaluate their own efforts.

A Mother’s Movement Against Bullying

Jane Clementi is the founder of the Tyler Clementi Foundation, which works to end online and offline bullying in schools, workplaces, and faith communities. She started the advocacy organization in 2011 to honor her son, Tyler. He died by suicide at age 18 in the first month of his freshman year at Rutgers University. Among the foundation’s programs is the Million Upstander Movement, in which enlistees pledge to stand up to bullying and treat others with kindness, respect, and compassion. The Sophie Fund’s Anna Moura spoke to Jane Clementi via Zoom on October 28, 2020.

Tyler and Jane Clementi [Courtesy Jane Clementi]

THE SOPHIE FUND: What drove you to create the Tyler Clementi Foundation?

JANE CLEMENTI: It was in the wake of my son’s death. He died by suicide in the fall of 2010 after he had been just started his freshman year. His roommate live-streamed him in a sexual encounter with another man. And then, as he read the comments and quotes on social media, his reality became twisted and distorted, and he made that permanent decision to a very temporary situation, and he died by suicide. It was to honor his legacy.

There were several high-profile deaths in the fall of 2010, but Tyler’s seemed to rise even up to the top of those and his story held national headlines for several weeks after that. Several noted celebrities continued to talk about Tyler over the course of time. As my fog lifted from the extreme distress that I was in after Tyler’s death, I realized that there was a lot of good positive conversation that was happening, and that those conversations were helping to create change, to make life better for other LGBTQ youth as well as just other marginalized youth that were being targeted.

I wanted to make sure that the world knew more about Tyler and the kind, caring, resourceful young man that he actually was. I also have come in years since to realize how distressed he truly was as well. I recently moved, within the last six months, and I came across more writings that Tyler had documented some of his pain and sadness and anger. It was someone I didn’t even recognize. I had no idea. So not everyone exhibits symptoms of their pain.

THE SOPHIE FUND: How do you define the problem of bullying?

JANE CLEMENTI: I think it’s a complex issue with a complex array of solutions. I think it’s helpful for us to share our stories so that people are aware of the great consequences and harm that can be caused from bullying behavior. I like to make sure people know that not all bullying situations end in the same devastating way that Tyler’s story ended. But with that said, all bullying hurts when it is happening, and it often leaves lifelong scars, whether physical or emotional, psychological scars.

I also think it is an issue that needs our constant attention and immediate attention. I don’t think it’s “kids just being kids.” I don’t think it magically disappears when someone turns 18. It’s behavior that goes on uncorrected and unchallenged. We have to identify that behavior early—the earlier, the better—to make change. Legislation is important, but I think it’s just a small component of creating change. I think most legislation sets the boundaries, which I think is key and important, but after that once the boundaries are crossed, it is very punitive. It mostly deals with punishment or suspension. I don’t think that that changes the behavior. I think we need to implement more behavior modification, and maybe reward positive behavior and call out positive behavior as part of the solution.

We are working preventing bullying online and off, as well as in schools, workplaces, and faith communities. Because I think it happens not only to youth, and not only in schools, but also through legislative inequalities as well as religious dogma that targets especially those in the LGBTQ community. We can go further down to the root of the cause and that will help prevent it for other people.

THE SOPHIE FUND: What can we really do to make an impact on bullying behavior?

JANE CLEMENTI: We have a few initiatives ourselves with the Tyler Clementi Foundation that we think will impact that behavior. First of all, we think it’s important to realize that there’s more than just the target and the aggressor in a bullying situation. But there are bystanders. Almost all situations have bystanders, people who see what’s happening. And those are bystanders because they’re passive and remain silent. That is like condoning and supporting the aggressive behavior. So, we want to empower those bystanders, and we call them “upstanders” once they become empowered. We think that there are many ways to do that.

You can intervene and interrupt a situation if you feel comfortable and if you know the people involved. Because we never ever want anyone else to come into harm’s way. Sometimes it’s as easy as, if you know the people and maybe think they are using racial slurs or homophobic slurs as jest or some type of humor—which they are not—and calling it out and saying that this isn’t funny.

It might even be as simple as coming beside the person being targeted and calling them away and pulling them physically out of the situation, saying, “Come with me, I want to show you something I saw outside, or down the hall,” or whatever.

If you don’t feel comfortable in that situation, or if the behavior doesn’t get changed, it’s about reporting it to a trusted adult or a youth. Or reporting it to the proper people if it’s happening in the workplace, up your ladder, your chain of command, your human resources department, something to that effect.

If you have someone’s best interest at heart, it is not tattling, or telling on someone. It’s about finding them the right support, which takes us to the third easiest way. That is to reach out to the target. I think that that is important. I think if someone had reached out to Tyler, it would have made all the difference for him. Making sure they know where their resources are. Tyler had resources at Rutgers, and he had resources at home. But no one made sure he knew how to reach out. And when you’re in a really dark place, and I learned personally, you don’t often see your resources. You just see the pain and the bleakness. So reaching out to the target, making sure, sometimes it’s just about making sure they know you’re there, you’re a friend. I think those are key elements of being an upstander.

We also believe that its more than just a one-on-one but about creating safe communities as well. We believe that someone, if they say on a first day of a group meeting together, whether it’s a sports team, or a club, or a classroom, or an entire school, having a person of authority set the boundaries, and say that we value everyone here, we will not accept anybody being targeted or humiliated for any reason. And then calling out and enumerating the reasons. Such as body shape and size, or abilities, or what language they speak at home, or their sexual orientation, or their gender identity, or whatever else makes somebody special and precious.

We do think people are targeted because of their differences, and we need to enumerate those differences so people understand that, and then get an acknowledgement back from the group that, yes, they understand. It is not a magic wand. The aggressor needs to hear where the boundaries are sometimes. It is also a huge message for someone who is marginalized to hear, to know that they are welcome and included in this space regardless of whatever makes them special.

THE SOPHIE FUND: Tell us about the “Upstander Pledge”?

JANE CLEMENTI: We started it several years ago. We wanted to reach a million people with our upstander pledge by October of 2020, and I’m pleased to say that we did just reach a million people. We’re really thrilled about that announcement, but we also know that a million people sounds like a lot, but it still needs to reach more. So we are going to continue our message.  It is also a message that needs to be heard over and over again.

Every time you are faced with a situation, it’s not like, “Oh, I signed the pledge, I’m good.” You have to really think about it. One of the things I’ve learned is that there is something called the bystander phenomenon. The more people that see an incident happening the less likely that somebody is to stand up to that incident. That’s why we need to have it fresh on our mind: “Wait a minute, nobody is saying anything. That’s me. I need to be that person that stands in the gap. I need to be the person to be empowered enough, and to have the courage enough, to stand up here.” And then hopefully you’ll be the leader to create a wave of people that will stand up to that.

THE SOPHIE FUND: How does the foundation’s work specifically impact LGBTQ youth?

JANE CLEMENTI: Our mission is broad in that it speaks to anyone’s difference. With that said, I think that allows us to speak specifically where we go and where we are invited in to talk. We are not quite as problematic for some schools or for some businesses that might not be able to or want to invite, say, GLSEN, or GLAAD, or HRC. And yet, for us, that is a huge focus of our work because that is part of Tyler’s story. Tyler was a gay youth, so we can speak to that. We have a gentle way of bringing that conversation to the organization that we are speaking in.

THE SOPHIE FUND: How do you view the problem of cyberbullying?

JANE CLEMENTI: With Covid we are spending so much more of our time in the digital cyber world, so the incidences of cyber-attack or bullying are so much greater. We have to be sure and think about the words that we’re using, and say the words that are building other people up and not attacking their character. I think it’s important that we see the humanity behind something and being willing to back up whatever we say by saying it to someone’s face, not saying it just through words on a screen.

THE SOPHIE FUND: Can you talk about the Tyler Clementi Higher Education Anti-Harassment Act?

JANE CLEMENTI: A little history. It was created and introduced into the Senate initially by the New Jersey’s senator at the time, which was Senator Frank Lautenberg. He realized a truth which I still see today, that there is no federal anti-bullying legislation at all. Since Tyler was a college student, he initiated the bill to speak to colleges and universities, higher education institutions, to create policies and programs to protect all their students.

In 2010, in the fall, there were very few state laws for anti-bullying. I think New Jersey instituted one of the first. New Jersey’s law is called HIB—Harassment, Intimidation, and Bullying. That passed shortly after Tyler’s death. At this point, all 50 states have some form of anti-bullying legislation. Which also means each state has a different definition of what bullying is. There are 50 different definitions out there. And so I do think we do need a federal law.

There are several that are out there. The two that are most known are the Safe Schools Act, which would be K-12, and that is supported by the Human Rights Campaign, and several other organizations. And then there’s theTyler Clementi Higher Education Anti-Harassment Act. That is also supported by HRC and a few less organizations than the Safe Schools Act. But it does not seem to get passed legislatively. Maybe with the new Congress we can get that moving forward.

THE SOPHIE FUND: What do you think is needed specifically in higher education?

JANE CLEMENTI: One of the things with LGBTQ support is that many colleges and higher education institutions do not have a resource person or an LGBTQ center on their college campuses. Out of 6,000 institutions, only less than 10 percent had a resource person, one FTE employee who was in charge of the resource center. So, I think that there needs to be more resource availability available through a center through a place where people can gather together and receive the support that they need.

Most institutions also need policies in place to protect all students and calling out and enumerating classes including LGBTQI+ students as well. With those policies they should have trainings for staff as well as for students. Those are components of Tyler’s bill also. Having not only policies in place but trainings for staff and students.

THE SOPHIE FUND: Can you talk a little bit about the Tyler Clementi Center at Rutgers University?

JANE CLEMENTI: We have a Memorandum of Understanding with Rutgers that created the Tyler Clementi Center at Rutgers. It falls under the inclusion and diversity chancellor. They are working towards having research and symposiums. For all marginalized students, but the last two symposiums have been specific to LGBTQ, creating safe LGBTQ spaces on the college campus. They just did a web conference, the topic was “Out of The Closet.” It was discussing the safety aspect of being in the closet against the harm of being in the closet, which usually outweighs the safety. It was about not forcing people to come out before they were ready to come out. But how to rather encourage people to see the positive aspect of being out, and the better emotional mental health of it.

The Clementi Family at Tyler’s high school graduation 2010 [Courtesy Jane Clementi]

THE SOPHIE FUND: How do you view bullying in the context of today’s divisive political scene?

JANE CLEMENTI: We never will agree with everyone completely on solutions. But I do think it is key that we learn how to have those conversations respectfully and to talk about the issues and solutions to the problems without attacking someone’s character or the person. I think that’s one of the things that we haven’t achieved very well in our political system right now. As a nonprofit, we don’t endorse any candidate at all, but we certainly need leaders that will exemplify and model good behavior for us and not call out and target and attack a person’s character but have those respectful conversations.

 Until we do, I think it definitely affects youth today. You might dismiss it, but there was a research project out of the University of Virginia that talked about the last political campaign for the last election. It showed that bullying behavior increased among youth after certain political leaders exhibited it on the television screen or their news media screen, and visualizing someone calling out news reporters for their disabilities, or calling out other people and attacking their personality.

THE SOPHIE FUND: Why did the foundation reach out to the 2020 presidential candidates to take the upstander pledge?

JANE CLEMENTI: They were going to occupy so much of our time through news, we thought it was important that the candidates, all of the candidates, would take our pledge and to live out our pledge in their campaign. We reached out in a bipartisan way to everyone running at the time, and we posted them on our website.

It is multi-faceted the answer as to why some people did not take the pledge. Obviously, it was interesting to me that all the candidates were from the Democratic Party that did sign our pledge. But even within that Democratic Party, there were some that did not take it. Some responded that they don’t sign pledges, and they don’t put their name to things that they don’t have control over. And I accept that. But we got most of the top contenders who were running which I think speaks volumes. If someone actually engages in bullying behavior, I would imagine that they wouldn’t want to sign the pledge.

THE SOPHIE FUND: How do you assess the “Be Best” initiative of First Lady Melania Trump? People have accused President Trump of engaging in bullying and not setting a “Be Best” example.

JANE CLEMENTI: I concur. I don’t think he would be the best example. I don’t think her initiative is as robust as it should be either. I see very little about it. Maybe I’m just missing it in my news area. I do know that she had one conference and I know some people who attended the conference. I didn’t even know that it was happening until after the fact. I think it was shallow at best, and I think she could have had a larger and stronger voice in this area. Although it’s very difficult when you are trying to reap change for good and one of the people involved on the other side and is occupying so much media attention is actually being the aggressor in many situations. and being the aggressor without knowing that he even is the aggressor. I have to have a good view of everyone. I can’t imagine someone wants to be an aggressor or wants to inflict cruel pain on someone else. I think sometimes it is just not even in their consciousness that they are being that type of an aggressor.

—By Anna Moura

Anna Moura, an intern at The Sophie Fund, is a Class of 2021 Writing major and Psychology minor at Ithaca College

[To learn more, check out local, state, and national resources on bullying at https://thesophiefund.org/bullying]