MARSHALL - Suicide is the second-leading cause of death for Minnesota teens, and the third nationally. So what is happening in our society that contributes to the long road of despair that children are facing, where they feel there are few choices available to them?
While some experts blame it on bullycide, a term that reflects child suicide caused by bullying, which Neil Marr and Tim Field introduced 10 years ago with the release of their book called "Bullycide: Death at Playtime," others suggest that it has something to do with increased mental health issues in children. Regardless of the reasons, more and more American children are struggling to reach adulthood without negative repercussions.
"We really need to take a look at mental health issues and situations that can occur with all of our kids," said Mary Kay Thomas, Marshall Middle School principal. "We need to make it something we can talk about so we can help all of our kids."
The American Society for the Prevention of Cruelty to Children reports that on any given day, an estimated 160,000 students in the United States refuse to go to school because they dread the physical and verbal aggression by their peers. The emotional toll can result in headaches, anxiety, stomach pains, shame, irritability, aggression and depression. Victims may also think about suicide more.
According to KidsHealth, one of the most painful aspects of bullying is that it is relentless. The report revealed that most people can take an episode of teasing, name-calling or being shunned at the mall. However, when it goes on and on, bullying can put a person in a state of constant fear.
"I will argue that whomever the child is, if they are internalizing what is said to them and if they are truly considering suicide, we need to look for mental health services," said Deann Reese, licensed social worker at Minneota School. "Suicide should never be an option for anyone no matter what they are going through."
According to the National Youth Violence Prevention Resource Center, nearly 30 percent of students in grades 6-10 have experienced bullying.
For educators, parents and even the adolescents themselves, it can be difficult to distinguish between intentional, repetitive bullying, less-complex day-to-day conflict and mental health issues.
"I think many of our parents get confused about the definition of bullying," Thomas said. "There is bullying, definitely at MMS, just like any other middle school, but the difference between bullying and conflict is vast."
Bullying is something that happens for a long period of time, Thomas said.
"It's a pattern and you're a target," she said. "Whereas, if somebody just bumps into you and says something really mean, or calls you a name, it doesn't necessitate that it's a bully situation, though we still need to address it."
Thomas said she isn't convinced that the majority of issues in schools are bullying, though the ones that are, certainly need to be dealt with.
"When we talk about a number of kids who have more of a mental health issue than they have a bully issue, I think we convolute what bullying is," she said. "We have many different issues in all of our schools, in our communities and in our families. Somehow, anytime there's a conflict, it becomes a bullying issue."
Along with mental health issues, true cases of bullying, however, need to have some sort of intervention take place.
"We work on problem identification and taking ownership of the problem," said Gloria Sabin, clinical director at Western Mental Health Center in Marshall. "We look at how the child is responding to the stress and what coping skills they already have and where they need to strengthen them. The emotion is tied to how they think about the problem."
According to the Suicide Awareness Voices of Education (SAVE), more than 5 million youth suffer with depression each year. Females are twice as likely to suffer from depression as males. But some experts say that boys are less likely to talk about it.
"If the kids come in, I feel like they're pretty strong-willed people and we're going to help them get through it," Thomas said. "Our biggest concerns are the ones who don't come in."
Sabin said she's noticed a significant amount of anxiety or depression in teenagers, and more recently, she's seeing it happen at a younger age.
"Some children identify it as bullying, but they use other words like being picked on or being teased," Sabin said. "Most of the time, it's about a relationship where people are relating in a negative way."
Sabin said she has seen effects vary.
"It seems to depend on those internal resources that each child has," she said. "I believe bullying is wrong, period. And, even though they shouldn't have to, some children just have better coping skills. They're better able to detach from negative actions."
Research done by Arseneault, Bowes & Shakoor in 2010 indicates that there are personal characteristics that increase a child's risk of being bullied, including low self-esteem, internalizing problems, low assertiveness and aggressiveness in early childhood. The report also found that bullying, and especially chronic bullying, has long-term effects on suicide risk and mental health which can persist into adulthood.
"Life is all about problems and how we learn to handle them," Thomas said. "It's different problems every single day, and some of them are nominal and some are very significant. But our lives are all about how we're going to address them."
Experts stress the importance of seeking help.
"The stigma has come a long ways in the last decade," Reese said. "People used to look down on other people for needing help, but that's changing. I have people coming to me all the time. It can be a huge benefit to have an impartial third-party person to talk to."
Unfortunately, for whatever reason - not wanting to rat on schoolmates, feelings of humiliation, embarrassment or shame, fear of retaliation or a belief that they can handle it themselves - kids remain silent.
"Some kids don't want to talk to anyone about being bullied," said Fay Prairie, a counselor in the Marshall area. "They think it'll go away. All of a sudden, it might spiral out of control and hit the person so hard. Then they get in over their head. They can get to the point of depression and not think clearly."
Reporting signs or threats of self-harm are crucial, experts said.
Bullying statistics suggest that in 85 percent of bullying cases, there is no intervention or effort to stop to action from taking place. Ashley Billasano, an 18-year-old from Texas, tweeted about her intentions to kill herself 144 times, but not one follower reported it. Sadly, she followed through on the threat.
The reality is that there are no foolproof predictions or answers. A recent CNN study, done by Anderson Cooper in partnership with sociologist Robert Faris, found that patterns of cruelty and aggression have more to do with jockeying for status rather than the stereotypical schoolyard bully preying on a weaker schoolmate.
"It's really not the kids that are psychologically troubled, who are on the margins or the fringes of the school's social life," Faris said. "It's the kids right in the middle, at the heart of things ... often, typically high-well-liked popular kids who are engaging in these behaviors."
According to a Cyberbullying Research Center survey, approximately 26 percent of girls ages 12-18 have been victims of cyberbullying, compared to 16 percent of boys. The survey also found that girls are more likely to spread rumors, while boys are more likely to post hurtful pictures or videos.
A recent Associated Press-MTV poll found that 1 in 4 teens admitted to being involved in sexting - sharing sexually explicit photos or videos by cell phone or online. The study also revealed that 17 percent of the people who received naked pictures admitted to passing them along to someone else, which happened to Jessica Logan, a recently-graduated Ohio student, and Hope Witsell, a 13-year-old Florida student. Both committed suicide after reportedly being taunted relentlessly with vicious smears.
After enduring years of abuse at her school, Marjorie Raymond, a 15-year-old Canadian student, wrote a note, blaming her suicide on: "the jealous people in this world who only want to destroy happiness."
Even elementary students are at risk. According to the American Association of Suicidology, suicide rates among 10- to 14-year-olds have skyrocketed more than 50 percent in the last 30 years. In the past two months, two 10-year-old girls - Ashlynn Connor, an Illinois fifth-grader, and Jasmine McClain, a student from North Carolina - took their own lives.
Prairie, who now gives presentations on relationship issues, encourages people to pay attention to each other. Too often, children don't reach out and the signs are missed. Prairie's son Luke, a bright, popular athlete, took his own life in 2009.
"Kids don't always think about consequences," Prairie said. "That's why they need adults to help them. The frontal lobe, the part of the brain that thinks about the long-term consequences, doesn't actually develop fully until their early 20s. At a younger age, they're more impulsive and they're going to make mistakes and keep learning."
Four years ago, Marshall's Kim Sanow started the L.O.L! Club, a safe place where young girls can go to learn positive social skills. The club is funded by House of Hope, a home for healing teens, the United Way of Southwest Minnesota and the Evan Carrow Foundation.
"The foundation is really set up to help young people who are experiencing bullying," Sanow said. "Evan was a really sensitive kid. The foundation is looking to raise awareness of teen depression and also crisis intervention for area youth."
Sanow believes she is having an impact in the Marshall area and has hopes of training other directors who can bring the L.O.L! Club program into their own communities.
A number of school districts in the area are also trying to make a difference. Many have contracted additional social workers to meet the needs of the student population. The key is building trust and providing a safe haven for the students.
"We have an open door policy, if a child is struggling with something or needs some help with friendship issues, they can just walk in," said Heather Bigler, MMS social worker. "We want to teach them and you want them to feel comfortable coming to you and not be afraid that they're going to get in trouble."
At Minneota, an Anti-Bullying Crew (ABC) is selling wristbands that say "Stop and Think...Words Can Hurt" to students, with the intention of showing their unity against bullying in Minneota schools.
Yellow Medicine East promotes mental health by posting signs around school property that read: "Middle school and high school students report in surveys that VERBAL bullying is the worst kind. It can actually cause depression, anxiety and fear of coming to school. Your words matter! Today in the hallway, challenge yourself to say something nice to someone who's not smiling."
Sabin pointed out that there is also a new "Stop Bullying: Speak Up" campaign managed by Substance Abuse and Mental Health Services Administration at www.samhsa.gov.
"If positive people in kids' lives can intervene, it can gives kids an opportunity to grow in their emotional development and coping skills," Sabin said.
Last month, in collaboration with SAMHSA and the National Suicide Prevention Lifeline, Facebook announced a new service that enables its users to report a suicidal comment they see posted. The user who posted the suicidal comment will then receive an email from Facebook encouraging them to seek out the free and confidential crisis counseling available through the National Suicide Prevention Lifeline (1-800-273-Talk (8255) or www.suicidepreventionlifeline.org).
Above all, tune in to the kids and be ready to listen, said Mayo Clinic child psychologist Dr. Bridget Biggs.
"Look for changes," she said. "Do they seem deflated while they're online or suddenly not want go to school? And listen. You never know when your teen may need to talk."