By LisaMarie Martinez
Options are what most adolescents feel is lacking in their lives. When such a lack is coupled with feelings of hopelessness, worthlessness, and purposelessness, all too often the only option within the minds of adolescents is the need to end it all, to commit suicide.
Although there are many avenues of treatment to prevent adolescent suicide from happening, issues of culture and society can act as barriers to treatment for adolescents of color who are suffering in silence with their suicidal ideologies. Because thoughts of suicide are considered mental health issues, the aforementioned barriers can become even more insurmountable for adolescents of color, which sometimes results in death.
Suicide is a public health issue that affects everyone; nationally there are more than 30,000 annual deaths related to suicide. In addition, the incidence of suicide has escalated within Colorado.
 “More people in Colorado die by suicide than by motor vehicle crashes and suicide is the second leading cause of death for Coloradans ages 10 through 34; therefore, it is imperative to encourage Coloradans to recognize and believe that it is OK to ask for help when feelings of desperation, depression, and suicide are overwhelming. Help is available,” said Jarrod Hindman, manager of the Office of Suicide Prevention in the Colorado Department of Public Health and Environment.
 Adolescents of color can refuse to talk to others because they do not think they will understand, but can also refuse to talk to mental health professionals due to cultural barriers influenced by language and values, explained Mary Ann B. Hewicker, licensed clinical social worker, emergency clinician and crisis intervention therapist coordinator of The Community Reach Center of Adams County.
“One of the major goals when I sit down and meet with a family is to build a rapport; which takes time to build. I introduce myself and my role, and then I try to connect as Mary Ann the person rather than Mary Ann the clinician by acknowledging that I am of a different culture and possibly a different lifestyle. I indicate to them that I am here to learn about their family beliefs, heritage, and religious aspects,” Hewicker said.
 Licensed clinical social worker Maggie Byrnes of the Aurora Mental Health Center describes the ability to form an alliance with a kid and their family as the ‘art’ of mental health.
“Sometimes forming an alliance with the kid and their family could mean going for a walk, going to the park, going to their home, or even going to McDonald’s. We will go to the family or meet them somewhere else in order to respect the family’s wishes to be seen in a place where they feel comfortable, and where they can escape the stigma of our building,” Byrnes said.
 Lynnette Holmes, a mental health coordinator for the Check Your Head Program at East High School, utilizes visibility, time, and consistency as a way to build trust with young people.
“You have to show your face consistently for people to trust you. They want to know who you are, what you want, and what you are doing there because they have this general feeling like they can’t trust anybody. It has taken me a long time to build rapport.”
Cultural Sensitivity Can Help Prevent Suicide
 In 1990, Shaka Franklin shot himself in the head at the age of 16. His mother, Marianne Franklin, soon saw the importance of fearlessly engaging in topics surrounding suicide, such as depression, so as to have control over it.
“Depression and suicide can be hard things for young people to even express, but by bringing the topic of suicide out, it changes the stigma of us talking about it,” said Franklin, who co-founded the Shaka Franklin Foundation for suicide prevention.
Depression not only involves sadness, grief and anger, but can include the absence of interest, excitement, joy, or happiness. It can run in families and sometimes cultures, just as alcoholism does. Therefore, barriers related to stigma must be removed for adolescents of color to receive treatment.
“Part of our education process involves informing the person and the family in family therapy that their suicidal ideology is not a sign of weakness on their part. Suicidal ideology can result in the feeling of isolation and give one the sense of sitting in one’s own little world which is very dark, very gloomy, and tends to be narrow. They’re feeling hopeless,” said Hewicker of the Community Reach Center.
 “African-American males are highly resistant to mental health treatment, because to them it is a sign of weakness. Consequently, some of our young people pick up that same ideology and run with it; they think (treatment) is a bad thing but in fact it is actually a good thing,” said Dr. E. D. Allen, forensic psychotherapist and CEO of the Office of Ministry, Counseling and Investigations.
“Our African-American communities struggle with the idea of having to go to counseling and if that is displayed among the adults and parents, then the adolescents will pick up the same mentality. You don’t have to be a Black therapist to serve as a minister to a Black client, or vice versa. This needs to be the mentality of both the professional and the client. We have to change our attitude or personal approach about mental health,” Allen said.
 “Treating mental health issues within the context of culture requires cultural sensitivity. A good therapist can show empathy and reach out to anyone of any culture or group, and can help them to deal with the issues they are dealing with through the utilization of cultural sensitivity in their practice,” said Ernest L. Chavez, chair and professor of the department of psychology at Colorado State University.
“The beginning of cultural competency is simply the willingness to learn more about and be open to the nuances of other cultures. The Latino culture has a strong foundation in the family system and their initial inclination is to resolve problems within the family system,” said Liz Pacheco, outreach coordinator and therapist at Second Wind Fund, which has a mission of decreasing the incidence of teen suicide by removing financial and social barriers to treatment for at-risk youth.
Sociological experts have said cultural contexts are the fabric that underlies emotional and rational thought processes within society. Other factors such as overall competence, area of specialty, temperament, and communication style can affect the provider-client relationship.
 “Clients have their own distinct set of needs and characteristics, but a poor fit will still be a poor fit even if the races of the provider and the client are the same. Yet an excellent fit in all areas other than race can still be very good,” said Jeff Lamontagne, co-founder and executive director of the Second Wind Fund.
Community Outreach Can Prevent Suicide
In addition to a change in attitude, a shift towards connectedness within the mental health community can assist in the delivery of care to adolescents of color who have attempted suicide or are considering it.
 Dr. Sara Jumping Eagle, a pediatrician and adolescent specialist, is Oglala Lakota, also known as Sioux. She attempts to meet the needs of her clients through her referral efforts to the MDS Counseling Center in Denver, which offers sliding fee scales. She works at the University of Colorado at Denver and Health Sciences Center, Denver Children’s Hospital, and Denver Indian Health and Family Services.
“The mental health community could help improve access to services for native teens and teens of color by promoting their services at community events, such as pow-wows, health fairs; and through outreach in the form of training of other organizations,” Jumping Eagle said.
 “We know that suicide is the second leading cause of death for young people in our state and that is why we believe that it is so important that parents, teachers, and peers are all educated about mental health issues and know where to go for help,” said Jeanne M. Rohner, president and CEO of Mental Health America of Colorado.
Public education, community grants, program support and evaluation, and reducing the stigma surrounding suicide and mental health treatment, are repeatedly pointed to as the staples of the suicide prevention.
“Mental health effectiveness must come from collaboration to meet the whole need of a person; i.e. the faith community, law enforcement, courts, and the department of human services. Everyone should take the time out to engage in maintaining their mental health ahead of time rather than waiting for crisis mode, when the damage is done” said forensic psychotherapist Allen.
In an effort for law enforcement in Colorado to begin such collaborative efforts, an ongoing relationship with community mental health was developed in the form of the Crisis Intervention Training Program (CIT).
“The CIT officers are trained in de-escalation, suicidal skills, and resources that instead of sending somebody to jail, they know how to link somebody up with an emergency room, or with a local mental health center,” said crisis intervention therapist coordinator Hewicker.
There also exists the back-door approach for those students who fear law enforcement in their school; which involves the ability to have a teacher or counselor set up a private meeting with their school’s onsite police, called school resource officers.
Allen said, “Some groups or organizations teach against the need for mental health stability, and use the village concept in the process. However, if that village is dysfunctional, then you will have a repeat of dysfunctionality, which then becomes the norm of that group or organization. They will fail to seek mental health treatment outside of it, and will only deal with their issues within the context of the group or organization. Thus, their dysfunction manifests itself within the community.”
The demeanor of an adolescent of color may not give clues to their suicidal ideology, and they can appear to function normally within the community.
 Although he came from a loving home and had everything going for him, on Sept. 5, 1997, Justin Mosby, an African-American male just shy of 20 years old, took a gun to his head while in his car on a lonely stretch of I-70. It was an Adams County officer that informed the Mosby family of Justin’s death. He is survived by his two younger sisters and his parents.
“I read books, talked to people who knew him, did research, talked to psychologists and parents who lost their children to suicide, and I do not understand to this day why he chose suicide. I was blindsided and never thought of suicide as being an option,” said Justin’s mother, Marrietta Theresa Joseph Mosby.
Mosby spoke with Les Franklin, co-founder of the Shaka Franklin Foundation, who lost his son to suicide with a gun in 1990. Franklin helped Mosby understand that suicide is illogical, she said.
“Suicidal kids do not turn to adults first; they turn to their peers first. That’s why we tell their peers, don’t ever keep the ‘secret’ when they swear to you,” Franklin said.
One of the ways parents can prevent an adolescent of color from committing suicide is through listening, as one mother of an anonymous suicide survivor of color explains, “Parents, we must listen, communicate, and love and support them through this ordeal; because it’s hard.”
SIDEBAR #1
The Story Of The Girl Hiding Inside Her Eyes
By LisaMarie Martinez
This real story of one young African-American girl’s suicidal thoughts may shed light on the topic in a way that clinicians can not. Though it may be difficult to understand her pain and reasoning, this local girl’s plight may open eyes to the situations that can lead to suicide, thereby creating the possibility of saving another life.
Her ojos de chocolate, chocolate-looking eyes, were successful in shielding her suicidal contemplations from those closest to her.
At 12 years of age, she was molested, causing her to lose self-esteem and change her hygiene and behavior.
“I thought I was a disgusting, nasty person. Out of the confusion, I became promiscuous, kind of, and I tried to develop a sexual relationship that was supposedly healthy, with older men,” our anonymous storyteller explained.
She turned to alcohol, which made her situation worse. She turned to another older guy, but felt molested again.
“I just wanted some kind of affection. I am ashamed to say that I had sex with him. It was horrible because I was drunk and had unprotected sex,” she confided.
At 15 and 16 years of age, she was still very promiscuous and “still kinda’ looking for love in the wrong places.” She started smoking marijuana, which put her in a state where she didn’t know what she was doing.
“From then on I felt worthless and that my life didn’t mean anything,” she continued.
It got so she couldn’t handle criticism, and would try to be someone that she wasn’t. She would lie to people, and try to convince herself that she was normal.
“That’s all I ever wanted was to be viewed as normal. I wanted to be like everyone else ‘cuz I thought that everyone else didn’t have this experience or go through these things and that they were normal,” she said.
She would do anything to please anyone because of her low self-esteem. She was easily led, easy to control; and weak.
“I didn’t want my life as a molested child to change me, but it did cuz I felt like everything was my fault and that I deserved what I got,” she admitted. “I didn’t wanna tell anyone, because I didn’t think anyone would understand my feelings.”
Relationships at school were awkward because she felt isolated and different.
“You just really feel like it’s just all about you and what happened to you. You think you’re the only one who’s been through that, when in reality there’s a vast amount of people who have been through the same thing you’ve been through. They just, either know how to handle it differently or they have more self esteem,” she said.
When she was 16, she slit her wrists.
“When I tried to commit suicide, all that was going through my mind was that I had failed in life greatly. I just started cutting and cutting and I just felt my wrists get numb. I just watched the blood flow out. I was waiting for me to bleed to death,” she recalled. “When my mom and my brother found me, I started to feel really bad because I didn’t consider their feelings.”
“After all of that, I emotionally emancipated myself and started setting standards of who I wanted to become despite my past. I wasn’t going to let anyone run over me, and that I was going to defend my self at any cost, and state my beliefs and intentions so everyone can know that I am truly a good person. Although bad things happened to me I don’t have to take them on forever,” the suicide survivor proclaimed.
“Where I am now I can see the truth, and kind of discern the truth; be able to tell things that are real and things that are not real. I had this feeling that everything was just coming down on me and that was basically an illusion,” she realized.
Since getting help, she feels a lot better. She takes medicine to help control her thoughts, and is learning how her body reacts to certain adverse drugs.
“You really have to have the confidence to know that you can be healed and that there are people who care about your well-being. Nothing in life is that bad to where you have to kill yourself. You may feel that way but you’re not alone, and people are there to help. Your life means so much more, not only for your family but to the world. You can actually help other people who have been through the same things that you’ve been through,” she said.
SIDEBAR #2:
Resources for Adolescents of Color
Many low-cost, no-cost, or sliding-scale-fee facilities and private mental health professionals are available to speak to adolescents of color, and treat them so they no longer consider suicide as an option.
Dr. E. D. Allen
drel@omci.us
303-756-9993
Aurora Mental Health Center
www.aumhc.org
303-617-2300
Ernest L. Chavez
Ernest.Chavez@ColoState.edu
970-491-6364
Community Reach Center
www.communityreachcenter.org
303-853-3500
Jarrod Hindman
cdphe.psdrequests@state.co.us
303-691-7901
MDS Counseling Center
info@mdscounseling.org
303-756-9052
Mental Health America of Colorado
www.mhacolorado.org
720-208-2220
Mental Health Center of Denver
www.mhcd.org
303-436-4100
National Organization for People of Color Against Suicide
info@nopcas.com
1-866-899-5317
Pikes Peak Mental Health Center
www.ppmhc.org
719-572-6100
Sara Jumping Eagle, MD
Sara.JumpingEagle@UCHSC.edu
720-300-4401
Shaka Franklin Foundation
www.shaka.org
303-337-2515
Second Wind Fund
www.thesecondwindfund.org
303-988-2645
Suicide Prevention Coalition of Colorado
www.suicideprevention-colorado.org
720-208-2249
Yellow Ribbon Suicide Prevention Program
www.yellowribbon.org
303-429-3530
Note: in case of an emergency, call 911
The Community Outreach Center emphasizes that the behavior of depressed adolescents may differ from that of depressed adults, and that parents should seek help if one or more of the following signs of depression persist:
--Frequent sadness, crying
--Hopelessness
--Decreased interest
--Low self-esteem, guilt
--Social isolation
--Extreme sensitivity to rejection or failure
--Increased anger, hostility
--Difficulty with relationships
--Frequent complaints of physical illnesses, headaches
--Poor concentration
--Talk of running away
--Thoughts, expressions of suicide and self-destructive behavior
Editor’s note: This information is not to be considered as comprehensive coverage of the treatment or topic of suicide, nor does it guarantee the ability to overcome the barriers to treatment significant to adolescents of color. It is meant to stimulate discussions of suicide with adolescents of color, and provide them with some culturally competent, cost-effective, accessible resources.
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