Only 20 percent to 40 percent of adolescents and children who attempt suicide receive follow-up care after receiving medical treatment in hospital emergency rooms, according to psychologist Alan Berman, PhD, of the American Association of Suicidology (AAS).

It's not that physicians aren't recommending or arranging follow-up psychological help, he says. Rather, even when appointments are encouraged, parents and their children fail to respond.

Berman, along with several other psychologists, presented a mental health perspective of adolescents and suicide at the Second National Congress on Childhood Emergencies held in Baltimore from March 27­29.

The sad fact is, said Berman, 60 percent to 80 percent of those youth who attempt suicide don't receive care again until the next time they harm themselves. Unfortunately, there is little information to indicate why compliance is so low or how to improve it. However, California psychologist Merritt Schreiber, PhD, who also spoke at the conference, notes that oftentimes physicians do not have access to follow-up mental health care.

"When culturally appropriate care is presented, many people avail themselves of those services when it's responsive to their needs," says Schreiber.

Suicide has become the third leading cause of death among young people ages 10 to 24. In recent years, suicide has increased at an alarming rate in younger adolescents, Native Americans and among African-American teen-age males. In addition, says Schreiber, a five-year study of 3,773 adolescents treated in emergency rooms in Oregon for self-inflicted injuries revealed that 27 percent of those cases involved individuals with a previous history of suicide attempts. Only the state of Oregon has mandated that all emergency departments report suicide attempts of adolescents 17 and under be reported to the state department of health and to refer those cases to mental health services.

Mental, behavioral and conduct disorders are some of the leading risk factors for adolescent suicide, reported Berman. Other factors include substance abuse and access to firearms. While noting that suicide prevention programs are critical--offering a full range of services from in-school education to crisis centers and hotlines starting for children as early as kindergarten--these strategies do not address some very important factors. For one, school programs miss a more significant at-risk population of adolescents who are not in the system due to trouble with the law, expulsion or because they have dropped out.

To learn more about suicide or suicide prevention and awareness, visit the AAS Web site: www.suicidology.org, the Centers for Disease Control at www.cdc.gov/ncipc, or the National Children's Center for Rural and Agricultural Health and Safety at http://research.marshfieldclinc.org/children.