Preteen Suicide Attempts on the Rise in Israel, Despite Prevention Program

Health Ministry statistics show a 44 percent rise in attempted suicides among boys and a 14 percent rise among girls in the 10-14 age group

A classroom in Kfar Bloom, Israel, May 23, 2018.
Gil Eliahu

Attempted suicides by children ages 10-14 have gone up by tens of percentage points in recent years, despite a special program created to assess and treat kids at risk.

Israel’s National Suicide Prevention Council published the numbers in its June report. Health Ministry statistics comparing the years 2007–2009 to 2016–2018 show a 44 percent rise in attempted suicides among boys and a 14 percent rise among girls in this age group. The findings are confirmed by data from ERAN, an emotional first aid hotline, which showed a spike in calls by children (including some under 10 years old) and teenagers pertaining to suicide.

Experts also point out that the age of children exhibiting suicidal behavior is dropping. According to Yochi Siman-Tov, the director of the unit in the Education Ministry’s psychological service that deals with high-pressure situations, children “are developing earlier physically and the world is open to them – the loss of innocence comes much faster.”

Three years ago the Education Ministry launched a special pilot program to train educators as part of the national suicide prevention program. The pilot program was then expanded in 84 communities, and the Education Ministry reported that it had trained 1,500 educational psychologists to assess children at risk of suicide, and thousands of others who came into contact with children in the school system were trained to be watchful for suicidal behavior. The vision – that a teacher would identify a child’s distress and immediately refer him or her to a specially trained psychologist in the community who would quickly construct a treatment plan – began to seem like a reality. The money flowed as well – a total of more than 20 million shekels ($5.73 million) was invested.

Today the plan is harshly criticized by the Health Ministry and educational psychologists. So what went wrong?

The program, it turns out, is an on-again, off-again affair with so many changes that school principals and psychologists have trouble keep up. “They don’t send us children anymore because they don’t know whether we are taking them or not,” says educational psychologist Oshrat Orgad-Katz, a member of the Forum for Public Psychology in Israel.

Last week, the forum sent a sharply worded letter to the ministers of education, health and finance, and their ministries’ director generals, decrying irregularities found last year in the transfer of funding for the program. At first the program was suspended because the Heath Ministry’s funding was not transferred, the letter said, and now it’s paused because of irregularities involving the Education Ministry. “The psychologists are getting confused messages as to whether the program even exists and children throughout the country are getting hurt,” the letter said.

The Health Ministry has expressed concern over the state of the program. “When you divide the number of risk assessments carried out by the number of psychologists trained, you get 1.5 assessments per psychologist per year,” said one expert involved in the program. Calling the training the educational psychologists by the state “a huge gift,” the expert said “the expectation was that a psychologist would do two or three risk assessments per week, and take approximately 10 children into treatment, as well as developing professional groups of psychologists to widen the response.”

The program was supposed to identify children at even the slightest risk of suicidal thoughts or behavior, and send them to the Education Ministry’s psychological service for assessment, for up to three sessions. In cases where the assessment showed a slight to medium risk, the child would then be given initial treatment of up to 12 sessions.

Experts believe that the program is an important step for removing the stigma, for both kids and parents, of referring children with suicidal ideation to psychiatric facilities. The process also filters out children who don’t actually need the service and would have been referred to it in the past because of some chance remark that might be interpreted as suicidal.

“It’s rare that we manage to have 12 therapy sessions with a student or parents,” said an educational psychologist who underwent the special training. “It’s a program that weighs too heavily on our regular work.” However, he doesn’t have any doubts the need for the program and its effectiveness. In one case, he assessed and treated a fifth grader who expressed a repeated desire to die, on WhatsApp and in other forums. “In the course of the sessions, the risk factors declined significantly and she became herself again,” he said.

In another case, the psychologist described a third grader who was assessed as being slightly at risk of suicide, but because the program was not operating at that time, he was sent to a psychiatrist in a hospital emergency room. “The encounter with the psychiatrist is unpleasant for children and parents. The psychiatrist asks difficult questions about psychotic states and all kinds of emotional issues,” he said. “Because the risk is usually low, the child is sent for continued treatment in the community and most of the time that doesn’t happen.”

Their experience in the emergency room means that parents and children “don’t want to hear about continuing,” the psychologist added. And according to Orgad-Katz, it can take months for a child to get treatment in the community.

Dr. Dana Lerer-Amisar, the head of children’s psychiatric service at Rambam Medical Center in Haifa said: “In places where the program is working, and psychologists have gotten the training, there are indeed very few referrals to the emergency room.” She said this happens not only when the program isn’t functioning, but because teachers “are more aware and panicked and are not prepared to take responsibility. I understand them,” she added.

Critics of the program say that it was also meant to train principals, teachers and the students themselves to identify suicidal iteration, and this has not been done. But Siman-Tov said that a directive from 2004 requires principals and teachers to refresh their knowledge of the protocols and the ministry holds seminars and conferences.

In general, Siman-Tov said, the program is active. “There were some difficulties in the transfer of payments and that caused a lot of irregularities and delays. I hope that now the program will maintain its stability and continue,” she said.