MYRTLE BEACH, SC (WBTW) — More than one in five children age 15 or younger seriously considered attempting suicide last year, according to a report, highlighting what experts say is a concerning trend of rising attempts by 10 to 15-year-olds.

“We have been looking at attempts for this age group, and we are concerned because since 2015, every year we have seen a slight increase, an uptick, in this age population,” said Jennifer Butler, the program director for the South Carolina Department of Mental Health Office of Suicide Prevention.

There were 48 children between the ages of 10 and 14 who died by suicide in South Carolina from 2015 to 2019, according to a Sept. 2020 report from the University of South Carolina School of Medicine. Another 89 between the age of 15 to 17 died by suicide, and 94 in the 18 to 19 age group died by suicide during the same timeframe.

The report identifies suicide deaths in the 10 to 14 age population as a a “demographic trend of concern.” Horry, Greenville, Charleston, Spartanburg and Richland counties are the areas with the highest raw numbers of death by suicide.

Those numbers continue to grow. Fourteen youth between the ages of 10 to 14 died by suicide last year, doubling how many died in 2015.

South Carolina’s rate was 16.2 suicide deaths per 100,000 people in 2019, up from 14.8 per 100,000 people in 2015, according to the South Carolina surveillance data. 

There were 123 youth suicides in 2019, bring the state to a total of 559 youth suicides from 2015 to 2019.

A family taking action

It took only days after Christopher Lawrence’s death for his parents to start looking for solutions. “Within one week, we determined that we would do anything we can to make sure other parents don’t go through anything that we went through,” said Larry Lawrence, Christopher’s father. 

Christopher died by suicide on Jan. 22, 2019. He was 14 years old.

Christopher was a “sweet scoundrel,” according to his family, with a personality that lit up a room. He was smart, but didn’t like school, and tended to be impulsive.

“Even as a young child, he would do something every day that would make us laugh or make us shake our head,” Lawrence said. 

He never passed up a dare, whether that was microwaving his school-issued laptop in seventh grade, or sticking a key into an electrical socket.

As a toddler, his parents would find him completely naked and covered in paint, or standing in his bedroom wearing ten sets of clothes.

“He looked like the Michelin tire guy, bulging out of the clothes,” Lawrence said. “He’d put on everything in his closet.”

(Courtesy: Larry Lawrence) Christopher Lawrence poses with a fish in 2018.

Christopher, who joined his family at 18 months and whose adoption was finalized when he was 4 years old, was diagnosed with ADD at 10 and placed on medication that helped stabilize his moods. 

His parents began spotting signs of depression when he was 12. After his grandmother died, he began withdrawing, and he started seeing a counselor.

After his death, his parents learned that suicide is the second most common cause of death for the 10- to 19-year-old population, with quick increases in the 10 to 14 age group.

They immediately started looking for ways to lower those numbers. They found Hope Squads, in-school groups run by students that aim to open up conversations about mental health.

“We were completely blown away and impressed by what we saw, the maturity of the students, their ability to communicate and share about mental health, express their feelings and care for their fellow students,” Lawrence said. 

They formed the Christopher’s Hope Foundation, which gained nonprofit status this summer, to raise money to put Hope Squads into every South Carolina school, with a focus on middle schools. They plan to expand to North Carolina and Georgia, as well. 

Students nominate their peers to serve on the squads. Lawrence said they were attracted to the program because they wanted a solution that focused on changing cultures within schools. 

They’ve started South Carolina’s first Hope Squads in two Spartanburg-area schools that Christopher attended. The organization is raising donations to pay for the startup costs of adding more schools. 

After Christopher’s funeral, his parents read message after message stating that Christopher was students’ best friend. They think he’d be supportive of the quads.

“He would probably be one of the people who would be on it,” Lawrence said. 

Starting the conversation

Greg Hudnall formed the Hope Squad organization after a fourth-grade student in his district died by suicide.

“It shocked our community,” he said. 

Hudnall, who was a superintendent of a school district in Utah, had staff spend a year talking to mental health experts and research suicide preventioning effforts. They wanted to know why youth suicide rates were increasing, and heard from principals that they were seeing fifth and sixth graders experiencing depression, anxiety and practicing self-harm.

After forming in 2004, there are now 900 schools with Hope Squads. About 200 of those are elementary schools. 

The elementary school program began two years ago after the organization kept hearing from principals who had students die by suicide.

“They kept calling,” Hudnall said. “They kept contacting us every week.”

There are separate Hope Squad models for elementary, middle and high schools. The elementary program is set up for the fourth, fifth and sixth grade and focuses on anti-bullying efforts, mental wellness and resiliency.

Hudnall said it takes a couple of years to change a school’s culture. What the squads do is encourage members to constantly reach out to peers and talk about mental health so that students know they’re not the only ones struggling. 

In one school, Hudnall said a ninth grade student gave a friend his watch, stating that he wouldn’t need it after the next day.

“He went on to tell five other friends that he was going to take his life, and none of those friends told an adult,” he said. 

The student died by suicide the following day.

“That is when we knew that we needed to have something that was comprehensive, kids talking to kids,” Hudnall said. 

As a former principal, Hudnall said it would take months for a school to recover from a suicide. Almost every educator who contacts the organization has lost a student to suicide in their area.

In the 16 years since its inception, Hudnall said more than 5,000 children have been referred for help and more than 1,000 hospitalized due to efforts from Hope Squads.

A growing concern

The real number of children who die from suicide is likely above the reported statistics because coroners aren’t able to rule a death as a suicide unless there is clear evidence that it was one, according to Jennifer Butler, the program director for the South Carolina Department of Mental Health Office of Suicide Prevention.

There were 7,081 suicide attempts in South Carolina in 2019, bringing it to a total of 28,763 suicides across all age groups from 2016 to 2019. There were 1,963 suicide attempts in Horry County from 2016 to 2019 across all group, according to information from the University of South Carolina School of Medicine.

“That is a tremendous amount of attempts,” Butler said. 

Because suicide attempt data is collected from hospitalizations, the real amount — like the death rates — is likely much higher.

About 16.3% of those aged 15 or younger had made a plan about how they’d attempt suicide, the highest rate of high school-aged groups surveyed, according to the 2019 South Carolina Youth Behavioral Risk Survey. For that age group, 9.4% answered that they had attempted suicide at least one time. Two-thirds of those under the age of 15 who attempted suicide were not treated by a medical professional for an injury, poisoning or overdose as a result of the attempt.

Reports specifically label females and those aged 10 to 14 as “demographic groups of concern.”

Black children ages 5 to 12 are also twice as likely to attempt suicide than their white peers, according to South Carolina’s 2018 suicide prevention plan. 

Butler said that South Carolina is one of a few states that reports suicide attempt data, which is crucial because it shows “the true numbers of distress” and helps the state do county-level interventions.

But since the state doesn’t receive suicide data from the Centers for Disease Control and Prevention until two years later, Butler said it can be hard to make real-time decisions about allocating resources.

The data they do have reveals that suicidal behavior and mental distress is happening at younger and younger ages.

“They are exposed to more prolonged stress, whether that is prolonged exposure through social media or communication on a 24-hour, seven days a week cycle where they can’t really escape,” Butler said. “Younger and younger, we are seeing kids with access to information that they aren’t positively able to process.”

The department does not track suicide information in those under the age of 10.

“We have heard anecdotally that there are kindergarteners who are expressing these thoughts,” Butler said.

She estimates that numbers will be higher this year because the pandemic has limited access to education and peer support. Natural disasters, the political environment and racial and social justice issues could also increase attempts. 

Butler said that stress weighing on parents can be brought home by adults and unintentionally impact children in the home. Children in unsafe home situations could be at additional risk. 

The 10- to 14-year-old population is commonly overlooked when it comes to mental illness and suicide awareness efforts. “I think that it is hard to believe that someone that young would-be struggling or suffering,” Butler said. 

She said that about half of mental illnesses are diagnosed during those ages as brains are developing.

“That early intervention is key,” she said. 

The culture is changing, however, and more resources are available for youth than ever before. Butler said The Office of Suicide Prevention has taken specific steps to target the 10 to 14 demographic. Those efforts include launching a partnership with the South Carolina Department of Education to offer 10,000 school personnel a training called Signs Matter, which was chosen because it is the only one to address elementary-aged children. The training teaches educators to recognize symptoms of anxiety and depression in kindergarteners, first and second graders in order to do early interventions. About 2,000 educators have completed the training. 

The office is also working on providing training that addresses children in the foster care system and will also launch a training for youth group leaders.

“We are really trying to think of where a child would interact, where we can provide access and education,” Butler said. 

Other efforts include partnering with the National Crisis Text line to create a local, specific code, HOPE-4-SC. The special code, Butler said, will provide county-level data on where users are. 

The state also recently launched an online mental health screener, making South Carolina the first state to launch one statewide to all citizens. Butler said parents and children can take it together, talk about results and then view links to resources.

Outreach is even more important with young children, Butler said, especially because it provides roleplaying opportunities of how to ask questions.

“The younger ones, they don’t have the language to say, ‘this is how we are feeling,’” Butler said. 

Ask, listen, refer

Warning signs in children include sleeping more or sleeping less, if they are talking more about death or say that they feel overwhelmed, like a burden, that they don’t fit in or that no one cares about them. 

“A lot of the things we say to look out for can be normal adolescent development or tween development,” Butler said. “They’re supposed to be a bit more moody, supposed to push back and withdraw from family and peer groups. So what you are looking for are really changes in the way they are behaving that would be a concern.”

She encourages adults to look at those behaviors through the eyes of living through a pandemic, which has changed behavior.

Firearms and medications should also be safely stored.

“Kids are impulsive,” Butler said. “That is in their developmental nature, and they don’t have the life experience that we have as adults to know that this situation will improve, that this situation will change over time. They only see what’s in front of them.”

Adults should ask children what is going on, acknowledge their feelings and then listen. Butler said that telling a child they’re too young to be feeling what they are will make children shut down and not open up about their struggles.

“With kids, we don’t want to think that someone that young is feeling that badly,” Butler said.

Adults should ask, listen and then connect a child with resources, which can include calling a crisis hotline together. 

What adults need to do more than anything, Butler said, is share messages of hope, and know that mental illness impacts every population.

“What is also important is that we remember that we are all vulnerable, regardless of what grouping we fall into, because we are human,” she said.