Wednesday, July 28, 2010

Bio-Recovery: The R&R Interview

by Jeffrey Stouffer editor
July 19, 2010

A continually evolving and expanding segment of the remediation industry, bio-recovery – better known as “crime scene cleanup” or “trauma cleaning” – has made great strides since it first came into being as an organized segment of the business almost two decades ago. Recently, R&R spoke with Kent Berg, director of the National Institute of Decontamination Specialists and founder of the American Bio-Recovery Association, to get his take on where the industry stands today and where it’s headed in the future.

Restoration & Remediation: Briefly, what falls under the scope of work when people talk about “bio-recovery”?

Kent Berg: Bio-recovery is actually a term that was derived from the words BioHazard Cleanup and Scene Recovery. We chose that term because our industry’s scope of work is actually much broader than cleaning crime scenes. We are often thought of as the guys that will clean up anything that is nasty, repulsive, or gross, so people naturally call us to clean up human feces, animal feces, dead animals – usually rotten ones – and gross filth, as in rotting food, poor hygiene, and piles and piles of garbage. Then there’s the decomposed human body scenes, meth labs, the occasional disease outbreak, and anything else that would cause a normal person to stay a hundred feet away to keep from puking.

R&R: You’ve been part of the bio-recovery profession pretty much since before it became a profession. Since that time, what are some of the biggest changes you’ve seen, both positive and negative?

KB: When I first started, very few people in this business knew anything about cleaning and disinfecting. They just wanted to make the visible contamination go away. No one in the insurance industry had ever heard of a crime scene cleanup company, and many adjusters argued that our services were not covered. Today, the biggest changes have been in our profile. What I mean by that is the public, who had never heard of our services, now see us in TV shows, documentaries, movies, magazines, and newspaper articles. We have recognition now, and families are more aware that these services exist.

Another change has been in the performance of the cleanup itself. We as an industry are much more aware of the antimicrobials we are using, the techniques and knowledge related to home construction, vehicle dismantling, and being able to actually render a property safe on a microscopic level.

R&R: From a purely objective point of view, bio-recovery would seem to be about as “recession-proof” as any remediation specialty out there. There will always be accidents, suicides and other traumas that require a professional remediator. What are some of the pros and cons that come along with that?

KB: We know that our services will always be needed, but with a higher profile, we are seeing more and more companies starting up, and more and more fire/water restoration companies adding this service to their menus. Although the demand for our services is increasing, the individual companies’ call volumes aren’t growing as fast because there is more competition for that finite number of incidents.

The pros are that the public will have resources to respond if they need them, and that companies will have to step up their game in service quality and marketing. The cons are that the majority of these new companies are not attending training, not getting any type of certification beyond a half-day OSHA bloodborne pathogen course. It’s these companies that are dragging the good companies down when the public hears about a company throwing a bloody mattress in a dumpster, etc.


R&R: Since hindsight is 20/20, if there was one thing you would go back and change, as far as how you operated your business, what is it, and what would you do differently?

KB: I would have marketed harder. I assumed that people would need my service and seek me out. That was true for a while, but when competitors popped up with their marketing programs, the public chose who was freshest in their minds. It’s a hard lesson to learn, but one I will never forget.

R&R: Technologically speaking, what areas have seen the greatest advances? Chemicals? PPE? Containment?

KB: One of the advancements has been our recognition as a legitimate industry. Today, vendors of specialty restoration products are targeting our industry. Kimberly-Clark markets their suits with the “Recommended by the American Bio-Recovery Association” seal on them. Other products used in our industry have similar tie-ins with our trade association or at the very least mention in their advertising that their product is great for cleaning crime and trauma scenes. Even the insurance industry no longer recognizes us under their “janitorial service” heading, opting now for a “crime scene cleanup” designation for insurance coverage.

We are also seeing new technology in the form of new disinfectants, odor-remediation technology, and devices to actually measure how clean a surface really is. The National Organization for Victim Assistance is putting on a training program this fall for teaching all interested bio-recovery technicians how to better interact with victims and their families. Meanwhile, the National Institute of Occupational Safety and Health has sought out input so they may better understand our industry.

However, I believe the most important advancement for the industry has been the formation of training centers. Legitimate training programs help make sure that any technician who wants to be the best at their profession can attend a school that specializes in that field. By establishing a standard training and certification program, students graduate far ahead of their competitors and benefit from years of experience from seasoned industry professionals, scientists, chemists, and pathologists that helped to design the curriculum.


Jeffrey Stouffer editor
stoufferj@bnpmedia.com

Jeffrey Stouffer is editor of Restoration & Remediation magazine

Sunday, June 13, 2010

Crime-scene cleanup requires technical, personal skills


Subtle eye needed to ensure work is completed properly

By JOHN PRZYBYS
LAS VEGAS REVIEW-JOURNAL
It's a question nobody ever wants to have to ask.

What happens after the homicide, or the suicide, or the death that nobody notices for days or even weeks? There's no way to put it delicately, but who cleans up the mess?

The answer: People such as John Gardner and David O'Brien, Southern Nevadans who own companies that specialize in the unusual, technically difficult and, well, just plain icky job of cleaning up crime scenes and other situations beyond the capabilities of traditional cleaners.

Most people "think the police will clean it up or the first responder -- the fire department -- will clean it up," says O'Brien, owner of Crime Scene Clean Team. But it is the survivors who must make the arrangements.

Specialized cleaners are required because blood, bodily fluids, bodily material and other residues are biohazards that can transmit infectious diseases. Consequently, cleaners must treat everything they come into contact with as potentially infectious, either to themselves or to a home's occupants.

The cleaners' workplace attire includes gloves, protective eyewear and booties at a minimum to disposable hazardous materials suits and respirators. After the job, those materials, along with paper towels and other contaminated items ranging from bloodied bed sheets to stained mattresses have to be treated as biomedical waste.

In addition to technical expertise, the job requires empathy and interpersonal skills. Cleaners work with people who have suffered a traumatic experience and, O'Brien says, the first thing his employees do on a job is to offer "our sincere condolences for their loss."

"It's not about the bucks. It's about helping those who need our services," says O'Brien, who has worked in the field for about eight years.

Particularly in cases of suicide or other deaths, "you have to have compassion for people," adds Gardner, owner of Absolute Decon Services.

The cleaners' work begins after receiving a call from a property owner, if the crime or cleanup scene involves private property, or a law enforcement officer or similar official if it involves a street or another form of public property.

Barbara Morgan, a Las Vegas Metropolitan Police Department public information officer, says the department has contracts with two companies for crime scene and building cleanups and another for cleanups that involve motor vehicle accidents.

But, she notes, officers don't recommend specific cleanup companies to the public because such a recommendation could be seen as an endorsement. So, finding a service falls on the survivor, via the phone book or Google.

After police officers, crime scene investigators and coroner's officials have finished with their jobs, a cleaner will assess the damage and offer a cost estimate. Costs vary, but Gardner says most jobs begin at about $400. Homeowners' insurance often covers the cost, he adds.

The cleaners' arsenal includes disinfectants, disposable towels, high-pressure cleaners, vacuums, a few specialized chemicals -- one that, for instance, can reveal hidden blood on surfaces -- machines that remove smoke and odors, and ample elbow grease.

It requires a subtle eye. For example, Gardner says, "you have to make sure there's no blood under the flooring. If there's blood on the carpet, you have to take the piece of carpet up, and if there's blood in the subfloor, you have to take that piece up."

"You have to look for the invisible, because if you don't get the invisible, eventually it's going to start stinking in the house and be a health hazard," Gardner says, adding a typical job takes from one to six hours.

"We get a lot of people who pass away of natural causes and are left unattended, and several weeks go by," O'Brien says. Then, the cleaning job involves removing products of the body's natural decomposition process, and can include handling insect infestation.

Ideally, the work is done with little or no damage to the home. Ultimately, O'Brien says, "we bring it back to its pre-existing condition as if (the incident) never happened."

Gardner estimates that about 40 percent of his business is crime-scene cleanups. The remainder involves cleaning up after suicides, industrial accidents, floods or fires and auto accidents, or dealing with what he describes on his business card as "gross filth."

"We clean up (after) hoarders," Gardner explains. "You'd be surprised. You have a lot of biohazards in some of those."

And, yes, Gardner says, "we work with some of the casinos. There are scenes their people can't clean up."

O'Brien estimates that 95 percent of his company's work involves trauma, albeit not all of the crime-related kind. He also operates a school for prospective crime scene cleaners that includes an online course and two days of hands-on training. The curriculum includes classes in such areas as hazardous materials, blood-borne pathogens and even terrorism, he says.

It's a specialized industry. There is "a lot of work out there, but there are also a lot of companies out there now," Gardner says, noting he has seen an increase from four companies when he started six years ago to "at least 10 others" now.

But it's not a job for everybody. Gardner says he has had hires who "decided they couldn't do it."

The intensity of the job can be difficult. "I guess the hardest ones for me is teenage suicide," Gardner says, "because it's a teenager, and I just feel that it's a life that shouldn't be taken."

The job can be rewarding, too, O'Brien says. "People with tears in their eyes, they come and say, 'Thank you.' That alone is priceless."

The satisfaction, Gardner says, lies in doing a job nobody wants to do, but which somebody has to, and doing it well.

"You get satisfaction that you're helping people through a dilemma they don't care to face," he says. "Whether you like it or not, it's got to be done."

Thursday, June 3, 2010

6 reasons why people commit suicide

by Alex Lickerman, MD

Though I’ve never lost a friend or family member to suicide, I have lost a patient.

I have known a number of people left behind by the suicide of people close to them, however. Given how much losing my patient affected me, I’ve only been able to guess at the devastation these people have experienced. Pain mixed with guilt, anger, and regret makes for a bitter drink, the taste of which I’ve seen take many months or even years to wash out of some mouths.

The one question everyone has asked without exception, that they ache to have answered more than any other, is simply, why?


Why did their friend, child, parent, spouse, or sibling take their own life? Even when a note explaining the reasons is found, lingering questions usually remain: yes, they felt enough despair to want to die, but why did they feel that? A person’s suicide often takes the people it leaves behind by surprise (only accentuating survivor’s guilt for failing to see it coming).

People who’ve survived suicide attempts have reported wanting not so much to die as to stop living, a strange dichotomy but a valid one nevertheless. If some in-between state existed, some other alternative to death, I suspect many suicidal people would take it. For the sake of all those reading this who might have been left behind by someone’s suicide, I wanted to describe how I was trained to think about the reasons people kill themselves. They’re not as intuitive as most think.

In general, people try to kill themselves for six reasons:

1. They’re depressed. This is without question the most common reason people commit suicide. Severe depression is always accompanied by a pervasive sense of suffering as well as the belief that escape from it is hopeless. The pain of existence often becomes too much for severely depressed people to bear. The state of depression warps their thinking, allowing ideas like “Everyone would all be better off without me” to make rational sense. They shouldn’t be blamed for falling prey to such distorted thoughts any more than a heart patient should be blamed for experiencing chest pain: it’s simply the nature of their disease.

Because depression, as we all know, is almost always treatable, we should all seek to recognize its presence in our close friends and loved ones. Often people suffer with it silently, planning suicide without anyone ever knowing. Despite making both parties uncomfortable, inquiring directly about suicidal thoughts in my experience almost always yields an honest response. If you suspect someone might be depressed, don’t allow your tendency to deny the possibility of suicidal ideation prevent you from asking about it.

2. They’re psychotic. Malevolent inner voices often command self-destruction for unintelligible reasons. Psychosis is much harder to mask than depression — and arguably even more tragic. The worldwide incidence of schizophrenia is 1% and often strikes otherwise healthy, high-performing individuals, whose lives, though manageable with medication, never fulfill their original promise.

Schizophrenics are just as likely to talk freely about the voices commanding them to kill themselves as not, and also, in my experience, give honest answers about thoughts of suicide when asked directly. Psychosis, too, is treatable, and usually must be for a schizophrenic to be able to function at all. Untreated or poorly treated psychosis almost always requires hospital admission to a locked ward until the voices lose their commanding power.

3. They’re impulsive. Often related to drugs and alcohol, some people become maudlin and impulsively attempt to end their own lives. Once sobered and calmed, these people usually feel emphatically ashamed. The remorse is usually genuine, and whether or not they’ll ever attempt suicide again is unpredictable. They may try it again the very next time they become drunk or high, or never again in their lifetime. Hospital admission is therefore not usually indicated. Substance abuse and the underlying reasons for it are generally a greater concern in these people and should be addressed as aggressively as possible.

4. They’re crying out for help, and don’t know how else to get it. These people don’t usually want to die but do want to alert those around them that something is seriously wrong. They often don’t believe they will die, frequently choosing methods they don’t think can kill them in order to strike out at someone who’s hurt them—but are sometimes tragically misinformed. The prototypical example of this is a young teenage girl suffering genuine angst because of a relationship, either with a friend, boyfriend, or parent who swallows a bottle of Tylenol—not realizing that in high enough doses Tylenol causes irreversible liver damage.

I’ve watched more than one teenager die a horrible death in an ICU days after such an ingestion when remorse has already cured them of their desire to die and their true goal of alerting those close to them of their distress has been achieved.

5. They have a philosophical desire to die. The decision to commit suicide for some is based on a reasoned decision often motivated by the presence of a painful terminal illness from which little to no hope of reprieve exists. These people aren’t depressed, psychotic, maudlin, or crying out for help. They’re trying to take control of their destiny and alleviate their own suffering, which usually can only be done in death. They often look at their choice to commit suicide as a way to shorten a dying that will happen regardless. In my personal view, if such people are evaluated by a qualified professional who can reliably exclude the other possibilities for why suicide is desired, these people should be allowed to die at their own hands.

6. They’ve made a mistake. This is a recent, tragic phenomenon in which typically young people flirt with oxygen deprivation for the high it brings and simply go too far. The only defense against this, it seems to me, is education.

The wounds suicide leaves in the lives of those left behind by it are often deep and long lasting. The apparent senselessness of suicide often fuels the most significant pain survivors feel. Thinking we all deal better with tragedy when we understand its underpinnings, I’ve offered the preceding paragraphs in hopes that anyone reading this who’s been left behind by a suicide might be able to more easily find a way to move on, to relinquish their guilt and anger, and find closure. Despite the abrupt way you may have been left, those don’t have to be the only two emotions you’re doomed to feel about the one who left you.

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.

Tuesday, March 16, 2010

An insight into crime scenes clean up services


Crime scene cleanup companies also clean unattended deaths, damaged environments due to tear gas, and other crime and distress scenes. The larger crime scenes that involve mass murder scenes, terrorist attacks and anthrax and other biochemical damage is also taken care by these companies. Crime Scene Cleanup services may also include bird and rodent infested areas. The cleaners in this case require special experience and equipment than a typical cleaning company’s experience and equipment.

Typically, crime scene cleanups start taking place only after the coroner’s office and other government bodies releases the “scene” back to the owner or some other responsible person concerned with it. The cleaning task can not begin till the police investigation is completely finished on the contaminated scene.

In most cases crime scene cleanup is a small business activity. Mostly, small cleaning services like carpet cleaning or water damage companies add services for Crime Scene Cleanup for diversifying their activities. The prominent and recognized organizations in this field of cleaning consist of the Institute of Inspection, Cleaning, and Restoration Certification (IICRC) and the American Bio-recovery Association (ABRA).

Earlier crime scene cleanup was a loathsome job but today it has become a lucrative business. Crime scene cleanup companies can charge anywhere between $100 to $600 per hour depending on the “level of trauma” and the quantity of hazardous material that the cleaners have to deal with and dispose of.

While a crime clean up service is ultimately a business like any other, advertising and marketing your services can be tricky. In a job that involves tragic death; most companies avoid mainstream methods of advertisement. Some choose the standard phone-book route while many others advertise on the side of their vans. Most of these companies largely depend on discreet options like passing out their business cards at service-industry gatherings, police stations and funeral homes.

An important requirement for success in this industry involves being considerate towards the sensitive nature of the work. There are certain crime scene clean-up companies that provide a grief counselor to the families at no cost while others offer discount to needy people. There are many countries where this type of service is funded by government or by religious organizations.

While some people call this emerging field a social trend of commercializing death, others call it plain capitalism. But for many others it still remains an essential service, a godsend. The fact is that whether you like it or loathe it but if you ever end up with blood and brains splashed all over your bedroom walls, you will definitely be relieved that there is someone you can call to clean it up.

Friday, March 12, 2010

Trauma Cleaning: Without Standards, The Pain Can Keep Coming

by Kent Berg
National Institute Decontamination Specialist

As an instructor in crime and trauma-scene recovery and a board member of the American Bio-Recovery Association, I am often approached by attorneys, the public and insurance adjusters to evaluate the service they or their clients received from other crime-scene cleanup companies.

For the most part, these are just routine questions from people who want to make sure that the service they received was within the normal parameters of good practice. But a few times each month I receive calls that just cause my stomach to knot up and my blood to boil.

With the bio-recovery industry in its 14th year, it is mind-boggling to find individuals who still decide that they are going to start-up a new company and declare themselves “experts” in crime and trauma scene cleanup without any research or training.

It is even more outrageous to find that, although they know almost nothing about the science, chemistry, biology or laws of our industry, they are charging fees that are often four or five times the industry average.

The majority of those operating in the industry today are honest, ethical professionals. It’s the few bad apples in the bio-recovery barrel, so to speak, that amplify the problems tainting our industry.

Example 1: The Hit-and-Run Guys
A husband argues with his wife in their kitchen. As she prepares supper, he grabs a shotgun and, standing in the doorway between the kitchen and dining room, blows his head off.

It is still daylight when the police arrive. In order to see better, they open the brain-splattered dining room drapes. Splatter is on the dining room and kitchen walls, but since the body fell onto the vinyl tile floor of the kitchen, the largest amount of blood pooled there.

The family asks the police about scene cleanup, and is directed to a local company. The company tells the family that payment will have to be made in cash prior to starting the job, and that the family will not be allowed inside of the house while the cleaning process takes place.

The family agrees and stays with relatives until they get the call that the job is complete and they can return. The company is long gone, and upon cursory inspection, the rooms look contaminant-free.

It is now night and, in an effort to keep neighbors from seeing into the dining room, the wife pulls the drapes closed. To the horror of the family, the drapes had apparently never been checked and still have blood and brain matter clinging to the material.

The kitchen floor appears to be clean but, when the wife walks across the floor, bright red blood spurts up between the tiles, making little puddles and polka-dotting her shoes.

If this isn’t enough to re-traumatize the family, the wife goes to remove the now-cold pot of chili from the stove and promptly throws up when she sees a 3-inch piece of her husband’s skull nestled neatly atop the pot.

The family contacted the attorney general for their state, who then called me to review the family’s statements prior to a decision on prosecution.

Example 2: The Little-Extra-on-the-Side Guys
A man who lived alone died in his bed of natural causes, but wasn’t found for several weeks. When the authorities were finally called, the decomposition could be smelled from the street.

When a crime-scene-cleanup company was called in, the man’s relatives were told that the odor had permeated everything in the house with disease. Their recommendation was that everything in the house should be removed and destroyed.

The family, already nauseated from the smell, relied on the “professional opinion” of the technicians and agreed to let them remove everything from the good silver and china to the appliances.

In short, every piece of furniture, appliance, electronic component and fixture was removed because they were declared “not salvageable.”

The relatives were then presented with a bill for approximately $40,000! If this wasn’t obscene enough, a few weeks later the family found many of the home’s contents that were supposedly “not salvageable” being sold at a local flea market.

Example 3: The Cutting-Down-on-Overhead Guys
It is standard practice for crime and trauma-scene cleanup companies to dispose of human-blood-contaminated items that can’t be salvaged. They do this by red-bagging and boxing these items and sending them to a medical waste processing facility. This includes dismantling recliners, mattresses, and other large items to fit in these containers.

In this case, a company responded to a gunshot suicide in an apartment. The victim had sat in his favorite recliner and put a pistol in his mouth. The subsequent wound bled profusely until there was no more blood for the heart to pump. This resulted in the complete saturation of the recliner.

In an apparent effort to save on labor and disposal fees, the crew decided that they would dispose of the recliner by wrapping it in plastic, putting it in the back of their truck and then dumping it in the woods of a neighboring county.

All seemed to go well until a few days later, when hunters found the chair and called police. Thinking that they had stumbled upon evidence of a homicide, the police launched a full-scale investigation that lasted for weeks and logged many detective hours before they were actually able to review the crime scene photos of every police department in the surrounding counties.

When the mystery was finally attributed to this particular crime-scene-cleanup company, not only were they slapped with fines for littering, they were saddled with reimbursing the cost of the investigation. Every law enforcement agency that heard about this dropped the company like a hot potato, and the subsequent media attention tarnished the reputation of crime-scene-cleanup companies everywhere.

I would like to emphasize the fact that these complaints are not clients disappointed with a poorly painted wall or an out-of-true vanity top. These are abuses by unscrupulous companies that are subjecting their clients to financial greed, improper disinfection, and re-traumatizing that no one should have to endure.

Could training and certification eliminate these types of abuse? Perhaps a good portion of them, but in the end, it is the honesty and character of the companies themselves that should be monitored. I believe the way to do that is to pursue standards, as well as meeting with our state legislators to create specific regulations for our industry.

Friday, January 15, 2010

Disaster and then Disease


By Elizabeth Batt

The International Federation of Red Cross and Red Crescent Societies, describes a natural disaster as a “sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources.”

The earthquake in Haiti that occurred on January 12, 2010, caused death and destruction, the extent of which has yet to be realized. Sadly, Haiti’s problems might be only just beginning. Often following the initial aftermath of any natural disaster there follows a second wave of deaths, caused by disease.

Types of Disease Prevalent in the Aftermath of a Natural Disaster
When a natural disaster strikes to the extent that it did in Haiti, the infrastructure of a country is decimated. Fresh water supplies, sewage disposal and power is destroyed or severely interrupted. What remains is often contaminated, initiating a vicious cycle that cultivates communicable diseases. In a third world country like Haiti, where resources are already stretched thin and immunizations are not standard practice, the loss of life is certain to be much higher because they’re simply not equipped to deal with an incident of this magnitude.

The study, “Management of dead bodies in disaster situations.” PAHO; 2004, indicates that little threat for communicative disease outbreak is posed by actual human remains. The threat comes from the survivors themselves, the destruction of their surroundings and an inevitable crowding situation caused by displacement. Without a continuous fresh water supply, survivors are forced to drink polluted water just to stay alive. Aided by the lack of adequate sanitary conditions, these pollutants are ingested and then defecated back into the water source. It becomes a breeding ground for communicable diseases.

Water-related Diseases
Water-related diseases include infectious diarrhea or norovirus, salmonella and cholera. Noroviruses are transmitted through the fecal-oral route after the ingestion of contaminated food and water. Once infected, a person-to-person transmission can occur. Noroviruses cause diarrhea and vomiting that without adequate sanitization amenities, continue to perpetuate.

Salmonella is often referred to as food poisoning. It causes the same symptoms as norovirus and can be present in almost any type of food. Salmonella is transmitted through infected feces that come into contact with a food source. People can become carriers of salmonella, transmitting the disease for life.

Cholera, transmitted by the fecal-oral route has an extremely brief incubation period of just 2-5 days. It can cause acute diarrhea, dehydration and kidney failure. Of all water-related diseases, cholera is perhaps the most insidious and can kill an adult within hours.

Crowding-related Diseases
The three most common crowding-related diseases are meningitis, measles and acute respiratory failure (ARF). Meningitis causes an inflammation of the membranes surrounding the brain and spinal cord and can lead to permanent neurological damage. Measles is a highly contagious viral disease that can cause seizures and coma. The complications of measles can include blindness and brain inflammation. ARF has a high morbidity rate of 50-70% in both children and adults. Caused by inadequate gas exchange, oxygen levels drop and carbon dioxide levels rise. An effect of displacement, over-crowding issues and poor nutrition, ARF is a major cause of death.

Vectorborne Diseases
Vectorborne diseases are caused by “vectors” such as mosquitoes that carry malaria. Earthquakes and other natural disasters can change a habitat, as evidenced in Saenz R, Bissell RA, Paniagua F. "Post-disaster malaria in Costa Rica." Prehospital Disaster Med. 1995;10:154–60. This change in habitat can create conditions that are ripe for breeding, causing an upsurge in outbreaks of malaria. Children are particularly at risk of contracting malaria, a virus that in its most dangerous form, can affect the brain and kidneys. Dengue, also carried by mosquitoes, can develop into dengue haemorrhagic fever. The spread of dengue can be directly related to inadequate solid waste disposal and water storage. Without treatment, fatality rates can exceed 20%.

Haiti's challenges are far from over and despite aid being sent to this ravaged country, the death toll as it stands now, is certain to rise.

Tuesday, January 12, 2010

Teen Suicide Risk Factors: Parents Are Too Often Clueless

By Nancy Shute

Suicide is the third leading cause of death among teenagers, and it's a tragedy that can be prevented. Given that almost 15 percent of high school students say they've seriously considered suicide in the past year, parents and friends need to know how to recognize when a teenager is in trouble and how to help.

Parents can be clueless when it comes to recognizing suicide risk factors, or at least more clueless than teens. In a new survey of teenagers and parents in Chicago and in the Kansas City, Kan., area, which appears online in Pediatrics, both parents and teenagers said that teen suicide was a problem, but not in their community. Alas, teen suicide is a universal problem; no area is immune.

The teenagers correctly said that drug and alcohol use was a big risk factor for suicide, with some even noting that drinking and drug use could be a form of self-medication or self-harm. By contrast, many of the parents shrugged off substance abuse as acceptable adolescent behavior. As one parent told the researchers: "Some parents smoke pot with their kids or allow their kids to drink."

Both teenagers and parents said that guns should be kept away from a suicidal teen. But since parents said they didn't think they could determine when a teenager was suicidal, parents should routinely lock up firearms, the researchers suggest. That makes sense. Firearms are used in 43.1 percent of teen suicides, according to 2006 data, while suffocation or hanging accounts for 44.9 percent.

The good news: Both parents and teenagers in this small survey (66 teenagers and 30 parents) said they'd like more help learning how to know when someone is at risk of committing suicide and what to do. Schools and pediatricians should be able to help, but we can all become better educated through reliable resources on the Web. These authoritative sites list typical signs of suicide risk, and they also provide questions a parent or a friend can ask a teenager to find out if he is considering killing himself. Here are good places to start:

The American Academy of Child and Adolescent Psychiatry lists signs and symptoms of suicidal thinking, such as saying things like "I won't be a problem for you much longer."

The American Academy of Pediatrics urges parents to ask the child directly about suicide. "Getting the word out in the open may help your teenager think someone has heard his cries for help."

The National Suicide Prevention Lifeline provides free advice to someone considering suicide, as well as to friends and relatives, at 800-273-TALK.

The National Alliance on Mental Illness's teenage suicide page makes the point that talking with someone about suicide will not "give them the idea." "Bringing up the question of suicide and discussing it without showing shock or disapproval is one of the most helpful things you can do," the NAMI site says. "This openness shows that you are taking the individual seriously and responding to the severity of his or her distress."