Detecting and Preventing Suicide among Teenagers

Melissa Ridenour

According to both the American Academy of Child and Adolescent Psychiatry and the Center for Disease Control, suicide is the third leading cause of death for youth ages 15 to 24. Teen suicide affects everyone. Family and friends feel a guilty sense that if they had only done something different, the suicide could have been prevented. Therefore, it’s important to understand its causes, how to detect potential suicidal vulnerability, and how to help prevent it.

Causes of Teen Suicide
As teens grow up, they often feel stress, self-doubt, confusion, social and interaction problems with friends, peer pressure, concerns about succeeding, and pressure to meet parental expectations. Some teens suffer from clinical depression as well. Most teenagers experience such feelings to a certain degree at some point in their growing years. Those who are overwhelmed with such feelings and are unable to deal with them are more at risk for suicide.

There are several causes for teenagers to potentially want to take their own lives. Anxiety or depression left untreated can be a contributing factor. Feelings of hopelessness, helplessness, and worthlessness can cause teenagers to contemplate ending their lives. Other contributing factors are lack of success in school, bullying at school, violence at home, divorce, death of a loved one, rejection by peers, and the suicide of a friend.

According to the Center for Disease Control, such pressures of life make it too difficult for some teens to cope. As a result, sometimes overwhelmed teens welcome suicide as an escape from the pressure and pain.

Detecting Teen Depression and Potentially Suicidal Teens
According the American Academy of Child and Adolescent Psychiatry, parents should be on the lookout for specific signs in their children that could be indicators for a potential suicide risk. Such indicators include withdrawal from family and friends, as well as a lack of interest in activities the teens formerly enjoyed. Parents should look for any change in eating and sleeping habits or in hygiene and personal appearance.

In addition, parents should watch for personality changes and rebellious or violent behavior. Difficulty concentrating, decline in the quality of school work, and persistent boredom and malaise are possible signs as well. Persistent complaints of stomach aches, headaches and fatigue could be symptoms of emotional problems that can be signs of potential suicidal tendencies.

Equally important signs to watch for include statements from teens that they are bad and that they feel terrible inside. Other verbal hints include such statements as, “I won’t be a problem for you much longer. It’s no use. Nothing matters anyway.” Such statements from teens are clear indicators that they may be at least contemplating suicide.

If teenagers start giving away cherished possessions or throwing away favorite belongings, a way of getting their affairs in order, parents should consider such behavior an indicator of the risk for suicide. In addition, parents should watch for any signs of hallucinations or bizarre or strange thoughts.

Teen Suicide Prevention
According to the American Academy of Child and Adolescent Psychiatry, if teens threaten to commit suicide, parents should take the threat seriously and immediately seek professional help from a qualified mental health professional. Parents should not hesitate to ask their teens if they have suicidal thoughts. Such a question will not put the idea into children’s heads, but will, instead, assure teens that someone cares and open up an opportunity for discussion about it.

Parents should determine if their teens are suffering from depression and, if so, get medical treatment for the depression. Counseling is a good preventive strategy for depressed or potentially suicidal teens as well. Counseling can provide teens with coping strategies for dealing with their life problems. Frequently, once teens learn how to cope with problems, their suicidal desires dissipate.

It is essential for parents to treat their teens with understanding, compassion and respect. Parents should demonstrate unconditional love, offer emotional support, and make their teens feel important, loved and wanted. Parents should demonstrate to their teens that overcoming their problems and life challenges is possible and that they will help them with such challenges.

Resources
Related information can be found in the articles, “Coping with a Bully: How to Stop Bullying” and “Strategies for Dealing with a Bully Dilemma”. The article, “Dealing with Grief” provides related information about dealing with the death of a loved one.

Homeowner's Responsibilities When Contracting A Crime Scene Cleanup Project

It would be an encompassing statement to say that no one is quite prepared to deal with a crime scene, particularly if it involves a homicide or a violent crime. For one thing, only a few people could even consider how to restore a home back to its previous state before the crime. A more distressing fact would be the reality that the people who are left with the task of cleaning up blood, human remains and other parts or fluids have to deal with all these gore left by someone they knew or is part of their family. Not only would this be emotionally tasking, it is quite hazardous as well.

During the past several years or so, the task of cleaning up after a violent death or a messy crime is left in the hands of family members or friends. Although they do not have to deal with the body itself, the remnants of possibly biohazardous materials and waste can put the health of cleaners at risks. In this area, professional crime scene cleanup services can be hired to perform and deal with the legal, emotional and safety aspects of a crime-scene cleanup. These professionals can deal with biohazards and are equipped to clean and dispose of such wastes.

The following is a brief discussion about crime scene cleanup work and how homeowners can get the proper services they would need should their household be involved in a violent or gruesome crime. Hiring the services of these professionals can spare these homeowners from the emotional agony of doing the cleanup themselves, however, there are certain things that homeowners are responsible for and should consider first before hiring these cleanup services.

A Background on Crime Scene Cleanup Services
Crime scene cleaning involves restoring the scene of the crime back to its normal state after officials have completed their investigative work and required information and necessary evidences have been collected and properly documented.

It was only recently when crime scene cleaning came to be known as CTS or Crime and Trauma Scene Decontamination. The main focus for this kind of work is to decontaminate the crime scene from possible biohazardous materials and remnants particularly those resulting from a violent crime or those involving illegal substances and other chemicals. Crime scene cleaners are trained to detect and clean potential biohazards, even those small enough and invisible to the naked eye.

These professionals have a unique set of characteristics to be able to deal with the rigors of this chosen field. They not only have the stomach to endure death and gore, technical enough to handle biohazards, but should also be sensitive enough to be sensitive and discreet to the family members left behind. These people would like to make a difference for the community by helping out grieving families in cleaning up their homes.

Crime scene services are on call for emergencies and can respond anytime whenever there is a crime scene. However, it should be noted that the crime scene cleanup crews are not in any way involved in the legal and investigative aspects of the job. Cleanup services also do not deal with the body directly as this is handled by the coroner or medical examiner, but they can deal with body remnants and by-products no matter what stage of decomposition the body was at the moment of discovery.

Crime Scene Cleanup Services and Your Insurance Coverage
Nobody would be certain about eventualities in the future, but it would always be the best approach to be ready for anything, and this includes clauses for crime cleanup services in your insurance coverage. In recent years, the inclusion of this clause in a homeowner's insurance policy has been a standard practice, however, it would still be wise to make sure that it is indeed included in your policies and are covered when such unforeseen events take place.

What to Look for when Hiring Crime Scene Cleanup Services
Although several companies have emerged in this line of business, finding the ideal company could still be a very taxing and complicated endeavor for a homeowner, particularly if he or she also has to deal with the emotional stress as a result of the crime. These companies have competitive prices for their services, which usually run in the average of $600 an hour. The price may be steep, but a homeowner should consider the emotional agony and biohazard risk should they opt to do the cleanup on their own.

When hiring a company, you should look for a group that has considerable experience and know-how in this line of work, particularly those with a good reputation in the field. This may cost you at the higher end of the bracket but the services you can get can be headache free and reassuring. These companies are on call 24 hours a day and have available websites and online resources.

Some companies already offer a list of specific prices for a particular scenario or crime scene, but it would always be a wise move to ask for price quotes after a thorough assessment of the scope of work. Most significant factors in pricing would be the amount of personnel needed to complete the task and how long the crew can perform the task completely. The amount of waste or gross factor can also determine the price quotations. As a rule of thumb, the more experience the company has and the more advance the type of equipments they use can determine the price ranges you may get.

Homeowner's Responsibilities when Hiring Cleanup Services
The following are some responsibilities that a homeowner has when selecting for a cleanup services that he or she will hire.

* The crime scene cleanup crew is called in only after the investigators and law officials have given the go signal to start filming.

* As mentioned earlier, crime scenes can involve hazardous materials and waste so the crime scene cleanup company you will hire should have the proper gear and equipment for these types of jobs.

* Crime scenes, particularly those involving violent death and crime, can have bodily fluid remnants as well as blood and tissues left at the scene of the crime. These are considered biohazards and should be handled safely. You should make sure that the companies you are selecting are capable and knowledgeable to deal and handle biohazard materials.

* The company should know what to search for when looking for biohazard materials during cleanup. They should be able to determine and interpret possible splatters of biohazard materials within the crime scene, and be able to establish the extent of the cleanup work your crime scene would require.

* It is the homeowner's responsibility to check if these crime scene cleanup services have the proper permits as required by your state.

* Wearing safety gears should be a prerequisite for the crew of the crime scene before starting with any of their cleanup work. In modern times, disposable protective gears are preferred, since they can offer the best protection against contamination. Protective clothing includes gloves, suits, respirators, and chemical resistant boots.

* The crime scene cleanup company should make use of special cleaning tools like customized brushes, special sprayers and wet/dry vacuum cleaners. These tools prevent direct contact by the crewmember to the hazardous materials. Some of these special tools include a steam injection tool that is used in sanitizing dried biohazard remnants. The company should also have special tanks and dispensers for treatment chemicals, including the waste containers where the biohazard wastes are to be collected. Homeowners should make sure that these companies have these equipments.

* Aside from the specialized tools, the cleanup crew should also have available supplies and cleaning products. Materials that should be included are industrial strength disinfectants, and should include hydrogen peroxide and other bleaches. To clean bloodstains, the crew should use enzyme solvers, which can also clean viruses and bacteria. To deal with the foul odor left by the crime scene, the cleanup company should have foggers, deodorizers and ozone machines.

* Crime scene cleanup services should be equipped with proper cameras to document the crime scene before the actual work can start. These photos can be used for legal matters and can be utilized for insurance purposes. As a back up, homeowners can take the photos themselves, but some may be too emotionally stressed by the situation and may not be able to take even the simplest of shots.

* Since the crime scene cleanup company is dealing with biohazard materials, the homeowner should ensure that the company is equipped with the proper containers and specialized transportation equipment that ordinary cleaning and janitorial services may not have. This is to prevent exposure of the biohazard materials to the general public and cause health risks.

Choosing the proper and most qualified crime scene cleanup worker is a responsibility by the homeowners to spare themselves and their families or friends the additional anguish of having to deal with the cleanup work on their own. Hiring a cleanup company to deal with the crime scene involves not only choosing a qualified crew with specialized trainings, but they should also be a crew that has a sympathetic nature and should thread the crime site with respect.

Visit the American Bio Recovery Association, a nationwide non profit association for further assistance at www.americanbiorecovery.org

Clutter is just the start for local hoarders

The Virginian-Pilot
By Nora Firestone
Correspondent

Margie Gummo fingered the holes in her 45-year-old sweater. She was finally giving in to her daughter's repeated request to discard it. Gummo hates to waste anything - always has.

"It still keeps me warm," she said, admittedly embarrassed by the irrationality.

The path from the front door to the spare bedroom of her Virginia Beach home, where she sat trying to make sense of it all, remained clear. But she shar ed the couch with crumpled blankets and various displaced items. Other surfaces harbored more papers, books, clothing and "stuff" than she could manage.

Throughout the house things inhabited the spaces where people once communed. Gummo had succumbed to debilitating anxiety and depression, initially extensions of a lifelong struggle with obsessive-compulsive disorder and compounded in 1999 by three significant losses: the death of her father, separation from her husband and relinquishment of the couple's planned "dream home."

"It was a lot to deal with," she recalled.

Fresh tears reflected the ongoing impact of past trauma. She's since lacked the mental, physical and emotional energy needed to keep up with the material stuff of daily life.

Gummo's standard for keeping up would be considered unreasonable by most. Her untreated OCD had always been an internal slave driver, undermining her judgment with a constant and negative critique of everything she did and thought.

The house was "never clean enough" while her children were growing up.

She'd vacuum constantly, scrub the same surfaces repeatedly and agonize for hours over things being misaligned or "out of balance," she said.

The house appeared meticulously clean, but at a grave and concealed cost. Gummo battled relentless self-badgering. Time she spent tending to objects meant time away from nurturing relationships.

Everybody suffered, whether or not they understood the dynamics or foresaw the impact.



Facing the problem

With an understanding of the history, the irony computes.

Gummo's surroundings have spiraled from overly controlled to out of control, yet the two remain poles of the same tense coil.

She recalled her son's perspective: "He left for college in 2000 and 'came back to a disaster,' " Gummo said. "The hoarding had started. "

Her dining room, family room and kitchen no longer function as purposed. Today, they warehouse knee-high stacks of unread newspapers, neat piles and boxes of things she's compelled to save, and bags of items that she'd like to donate - once she finds the "right" recipients. All along this spiral are the lines between reasonable and unreasonable actions, drawn with the marker of irrational thought.

Gummo, 62, has no problem discarding newspapers and magazines after she's read them cover to cover. Until they've been used up, they're "still useful," she said. Discarding them prematurely "feels wasteful," she said. Receipts for minor purchases made in the '90s should be OK to throw away, she thinks, but might she need one someday? Regardless, they're paper, with which she has difficulty parting.

"It's ingrained in me. I don't want to waste anything," she explained. "It's part of hoarding. But how many paper clips or rubber bands do I really need?"

Gummo's embarrassed, ashamed. She knows better, she said. People view compulsive hoarding as laziness or a lack of willpower.

"They say, 'You can get rid of stuff if you wanted to,' " she noted. "Easy to say, hard to do. The hoarder has to be in control of throwing things out, or at least give permission for someone else to do it."

Daughter Melissa Gummo, 23, feels frustration when she'd rather feel a bond.

The recent college graduate moved back home temporarily but can't have friends over because she's embarrassed. She eats out or from the freezer's lot of microwaveable meals "because the kitchen's a mess," she said. Years of environmental dysfunction have left her feeling unprepared for the future.

Even away at college, she felt socially impaired, she said.

"I'd never learned how to entertain in my own place," she said.

Melissa doesn't accept her mother's claim that hoarding is a disorder. She believes it's a choice.

"I think it's something that's all in (her) head, because everybody can have OCD tendencies" and not everyone hoards, she said.



Understanding the hoarder

"It's all in the head" is a common misconception by observers, said Lisa Zocco, a Norfolk-based licensed clinical psychologist who specializes in treating people with anxiety disorders and OCD, many of whom also hoard.

"People don't realize how disabling (hoarding) can be," Zocco said. "It's not a willpower issue. It's not about just throwing out the items; there's a whole way of thinking and behaving associated with how things are discarded."

Hoarding is considered a medical disorder, Zocco said, and is most often accompanied by medical and/or mental issues, including physical illness or disability, anxiety disorders, depression, brain injury or dementia.

People who hoard "tend to have difficulty processing information or making decisions, and many are lonely and socially isolated," she said. Some don't see it as a problem. Studies suggest a familial, or maybe genetic, component, as well.

Kit Anderson, a certified professional organizer in chronic disorganization and president of the National Study Group on Chronic Disorganization, a nonprofit organization, coined the term "overwhelm paralysis" to describe the shift to compulsive hoarding.

"They finally get to the point where the brain says, 'I'm not going there,' " she said. "There's a real paralysis that sets in, and it's very, very real - and it becomes impossible."

The study group examines "why people are disorganized and what special techniques and approaches are needed for them to be successful," Anderson said. It provides training and certification, based on the latest research by leading authorities, to professional organizers.

The group defines compulsive hoarding according to three characteristics outlined by experts Randy O. Frost and Tamara Hartl, Ph.D., "The accumulation and failure to discard a large number of possessions that appear to most people to be useless or of limited value; extensive clutter in living spaces that precludes activities for which the rooms were designed; and significant distress or impairment in functioning caused by the hoarding."

A free "hoarding scale," available at www.nsgcd.org, can help people determine the difference between common clutter/collecting and hoarding, and how problematic the behavior might be.

Gummo hoards the most commonly saved items: papers, clothing, boxes and bags. She does not save kitchen and bathroom trash or old food, and she does wash her dishes and clothes.

"I don't think I'd ever become a far out, full-fledged hoarder, because I know too much about the condition," she said.

Help and hope

Early warning signs of compulsive hoarding may include compulsive acquiring that impedes into or affects daily functioning, excessive storage in outside units or even digital medium, difficulty throwing out things that others wouldn't keep, avoidance and financial difficulties.

Hoarding can begin with simple procrastination or attention deficit disorder, said Nancy Watson of Virginia Beach, a certified professional organizer in chronic disorganization and founder of Harmony at Home Organizing.

In its early stages hoarding can often be managed with the assistance of a professional organizer trained in chronic disorganization. More serious cases, marked by potential health and safety hazards, often require medical- and mental-health assessment and treatment by a mental-health professional, Watson said.

Hazards can include the presence of pests, unsanitary conditions, blocked passageways, unusable appliances and home systems, structural overburden and fire-safety violations.

Cognitive behavioral therapy and exposure and response prevention - the gradual exposure to the anxiety-provoking condition and support in resisting the usual response - are the recommended treatment approaches, Zocco said. Medication can alleviate some of the related distress.

But a client must be willing to accept help, Watson said. Family members shouldn't overstep boundaries by clearing out the home or criticizing.

"It's a very sensitive issue, because the hoarding has to do with an inappropriate relationship with stuff," she said. "They don't trust people, so they invest and engage with stuff because it's 'safe.' "

The hoarder's boundaries, pace and "rules" must be respected within an established, trust-based rapport, she cautioned.

"It's an ongoing process," added Mary Frances Ballard of Orderly Places, a Newport News-based professional organizer with National Study Group on Chronic Disorganization training. "It takes time to establish that rapport and to train them in the process of letting go and what to keep and how to keep it.

"It's most helpful when they let it go and know that it's going to a higher use," Ballard explained.

Keys to success for hoarders include motivation, the assistance of experienced professionals and "love, support and understanding from loved ones," Zocco said.

Gummo said she feels good about recent achievements: letting go of her 45-year-old sweater, cleaning out a closet and raking leaves outside. She's learned to make short, manageable to-do lists, to praise herself for progress and to avoid some predictable pitfalls.

She has cancelled all magazine subscriptions. If she goes away she has undelivered newspapers credited to her account rather than held for her return.

But it's a daily struggle.

"I know I'm not alone in this, yet I feel like I'm alone," Gummo said. "I don't want to be criticized, I want to be understood. I want to overcome this."