Europe Cuts Teen Suicides, Israel Reluctant to Apply Model

Study reveals that in almost half of recent cases, teen’s friends knew of intention but told no one; discord over how to approach topic in schools.

Dr. Yossi Levi-Belz.
Moti Milrod

A background check into the dozens of Israeli schoolchildren who committed suicide in recent years has revealed that in most cases they came from a poor socioeconomic background, had difficulties at school and low grades, and were often absent from school. The average age of the suicide cases was 16. An Education Ministry examination showed that 46 percent of these children informed their friends of their intention to kill themselves, but this went unreported. This was not the only missed cue: 56 percent of those committing suicide had some previous contact with therapists such as school counsellors, social workers or psychologists.

These numbers underlie the Ph.D. thesis of Yochi Siman-Tov, director of stress management and emergency counselling services the Education Ministry. The interpretation of this data is at the root of a dispute between ministry officials and other agencies such as non-profit groups and academic experts, who disagree about the most effective way of dealing with the problem. The former claim that major strides have been made in schools, while the latter stress the long road still ahead, noting that the problem should be addressed quickly.

“Teenagers in distress cannot wait,” says Dr. Avshalom Aderet, who heads The Path of Life, a support group for families of suicide victims.

This week, the Health Ministry published a report about suicides in Israel. It states that 372 people took their own lives in 2013, more than the number of people killed in road accidents. The previous year saw 435 suicides. Among those between the ages of 15 and 24, suicide was the second highest cause of death among men and the third highest among women. Until 2013 there were 11 teenage suicides a year. This has dropped to single digits in the last two years, but the ministry is waiting to see if this is a genuine trend.

Dr. Avshalom Aderet.
Tomer Appelbaum

Siman-Tov collated the data from reports of committees set up by the Education Ministry after each suicide. The committees, which include a school superintendent, a senior psychologist, a counsellor and a representative of the local authority, interview eight to 10 people on average, including the parents of the dead child, close friends, teachers and other educators. The committees also look at relevant documents such as school reports, medical files and psychological evaluations. They have no power or legal authority and their aim is to collect information in order to improve ways of contending with the problem.

Siman-Tov’s thesis was based on 70 suicides that occurred between 2003 and 2011. The numbers, published here for the first time, allow a rare look into the characteristics of those committing suicide: 71 percent were boys, 77 percent were Jewish and 28 percent were new immigrants (9 percent were second-generation immigrants). On average, each had undergone four “serious life events” such as the death of a family member, family breakup or emigration.

Figures showing that 55 percent of them were absent from school for periods ranging from several days to longer periods are among the more significant findings. This should set off alarm bells at school, suggesting that preliminary examination and monitoring are in order, more important than an intervention by officials responsible for orderly attendance. Siman-Tov says that these absences should not be viewed as disciplinary matters, resulting in summoning the parents and rebuking the student.

While most of those taking their lives came from a low socioeconomic status, had difficulties with schoolwork and experienced serious life events, there was a subgroup of 20 percent with a different profile. These were students with high achievements and no negative life events. This group experienced a rapid deterioration in their self-esteem and functioning, with students committing suicide shortly after some humiliating event, without prior warning. Furthermore, in 60 percent of the cases the suicide was preceded by a serious argument, often accompanied by a sense of humiliation. In 25 percent of the cases the arguments were with parents, in 25 percent with school staff and in 10 percent with friends. Commonly, the crisis preceding a suicide lasted nine months.

Most of these students had some previous contact with a therapist and were known to the school counsellor. Thus, it is believed that further training of educational staff will not suffice and that talking to young people about suicide is required.

Arguments over talking to school students about suicide usually take place behind the scene. Siman-Tov’s study, which showed that in 46 percent of the cases friends knew about the teen’s intention but did not report it, strengthens the suggestion that working with students is essential, mainly in order to dispel the notion that talking to an adult is akin to tattling.

Optimal program

An international study carried out five years ago, including 11,000 students from 11 European countries and Israel, was designed to find the optimal program to prevent suicides among adolescents. The study examined three methods: training teachers as gatekeepers who can identify risk factors, training students to identify stress among adolescents while clarifying to them the importance of reporting to adults (the YAM program), and distributing questionnaires for the purpose of identifying at-risk pupils. After one year, the YAM program turned out to be the most effective, resulting in the most significant drop in suicide levels.

According to Dr. Yossi Levi-Belz, head of the Behavioral Sciences Department at the Ruppin Academic Center, “it turned out that the YAM program was the best and most effective in identifying new cases of suicidal behavior.”

However, the Education Ministry refused to apply this five-lesson program in Israel. “The European program is unsuitable for the population of Israel,” says Siman-Tov. “We’re building a different, more suitable one which will be tried on an experimental basis in a few dozen schools.”

In contrast, Aderet believes that “we shouldn’t wait for a comprehensive and adapted new program to prevent suicides here. The study showed that in Europe these lessons and simulation can actually save young people’s lives. I’m amazed at the decision to complicate the process and embark on a pilot study instead of right away taking preventive measures that have proved themselves.”

“It’s hard to understand why the ministry rejected a program that was developed by the best European researchers, one that is being successfully implemented,” said another source involved in the field.

The leader of the European study, Prof. Danuta Wasserman from Sweden, and Prof. Alan Apter, who is in charge of the Israeli section of that study, will attend an annual conference on suicide at the Ruppin Academic Center in May. The conference will be led by Drs. Levi-Belz and Sami Hamdan from the Academic College of Tel Aviv-Yafo. The first presentation of the Israeli part of the international study will be made at this conference. The study, held in 12 vocational high schools across the country encompassing 1,200 students, found that one tenth of the respondents had tried to commit suicide in the past. In 30 percent of these cases the students had not told anyone of this.

The survey was held in vocational schools that are supervised by the Economy Ministry, since the Education Ministry refused to distribute questionnaires in schools under its jurisdiction. This decision caused some surprise among activists in this area and led to the withholding of results from Israel in the official report.

Siman-Tov says that the reason for the ministry’s opposition was that “they believed that one should undertake active identification of at-risk students only on condition that there are suitable treatment services available. One can’t just detect it and disappear. It’s unethical. Not only was active detection unproven as the most effective preventive measure, the panic it evokes and the burden it places on professionals doesn’t always justify the investment. In schools that come under the Economy Ministry’s jurisdiction there is a support system, so it was reasonable to distribute the questionnaires there. We have too few professionals.”

“The Education Ministry decided that it’s better not to know the extent of suicidal tendencies among adolescents,” said one of the people dealing with these issues, preferring to remain anonymous. “It’s not clear that parents share this attitude. Many would prefer to know about such problems while searching for treatment in private facilities, rather than not knowing. With regard to alcohol and drugs, there is also no optimal solution but these issues are discussed in high schools, since raising awareness is considered to be important. This doesn’t apply to suicides.”

Another source familiar with the situation defined the withholding of the questionnaires as a “conscious decision to bury one’s head in the sand.”

According to Apter, one of Israel’s leading experts on suicide, “there is some improvement in the Education Ministry’s approach to the issue. Given that, it’s important to have programs that will prevent teenage suicides. It’s been proven internationally that these programs are effective and there is no proof that talking about it is harmful. It’s very important that relevant government ministries be open to studies in this area.”

A book dealing with suicidal behavior among youth has recently been published, edited by Levi-Belz. “It’s possible to prevent such suicides,” he says. “If we recognize the risk factors and warning signs, and mainly if we have the courage to talk about it, we can stop it before it happens, allowing teenagers to deal with their crises. We used to think that talking about suicide gives young people ideas. We now know that the opposite is true.”

Aderet adds that he “believes in the ability of the Education Ministry and in its willingness to promote the operation of a national program for preventing suicide in schools. We must talk to students about this issue. They have to know and understand that reporting a friend in distress is not tattling but rather the saving of a life.”

A month ago, Prof. Gil Zalsman, the director of the Geha Mental Health Center and head of the national program for suicide prevention, met with Education Minister Naftali Bennett, presenting him with Siman-Tov’s findings. The meeting explored ways of increasing the awareness of students’ absences from school and the need to report to adults.

“There is extensive knowledge about methods and strategies to prevent suicide,” says. Zalsman. “The American Foundation for Suicide Prevention has led an advertising campaign in order to convince children to report to adults, thus saving the lives of many adolescents. Such a campaign is needed here as well.”

The Education Ministry said it was “operating tirelessly to prevent suicidal tendencies,” and “is not refusing to hold workshops for students. On the contrary, such workshops are held in many schools and will be expanded next year. However, we won’t allow external unauthorized agencies to hold workshops on this sensitive subject. There is research that shows an increased risk of suicide if the discussions are not conducted by professionals.”