John Ackerman, PhD, is working to change the way we address the menace of pediatric suicide — in schools, treatment centers, public forums and the media — because he knows that getting it wrong can add to the carnage.
Ackerman, a clinical psychologist and APA member, is the suicide prevention coordinator for the Center for Suicide Prevention and Research (CSPR), founded in 2015 at Nationwide Children's Hospital (NCH) in Columbus, Ohio. He has done research himself, and he is acutely aware of what his field knows so far about best practices for intervening with children at risk for suicide. A big part of his job is getting that knowledge out to the community.
"We don't necessarily take the approach that every suicide is preventable, but many are. The more we can maximize that prevention element, the more the whole community benefits. Every suicide is the loss of a life, and I take that very seriously," he says.
About half of Americans have lost a friend or relative to suicide; recent research shows that one suicide affects 135 other peopleopens in new window. It is the second-leading cause of deathopens in new window among those ages 10 to 19. Many children who attempt suicide have been depressed, but others are impulsive or emotionally dysregulated; for them, suicidal thoughts can escalate quickly to action. Any child who has been bullied has some degree of risk, but so does the bully. Roughly one in six teenagers has thought about suicide in the past year; about one in 12 has made a suicide attemptopens in new window (PDF, 107KB). Often, the means chosen for an attempt will make the difference between life and death, Ackerman says.
"Most kids will not explicitly tell an adult they're feeling suicidal," he says.
"SOS: Signs of Suicide Prevention Programopens in new window," a widely used program CSPR takes into schools, encourages students to be alert to signs of unusual stress or despair in their friends (or themselves), and to tell a trusted adult if they see a friend floundering. It's also important that parents, educators and other adults learn to interpret signs that a child is at imminent risk.
Working with 105 schools in the Columbus area, and using a seven-item questionnaire, CSPR has screened 25,000 area children since 2015, and followed up with 900 who showed signs of depression or other risk factors — immediately, if the children were flagged as being suicidal.
"These are all kids who would not have been identified without the program," Ackerman says.
He also believes in using suicide-specific therapy, such as the Collaborative Assessment and Management of Suicidalityopens in new window (CAMS) strategy, alongside treatment for underlying depression or other conditions. Other models emphasize supporting the person at times when they are most vulnerable; intervening to bring the family closer together can help, too.
"We need to be a lot more creative" in working with communities, Ackerman says, because suicide rates among children are not coming down.
How suicide is portrayed in the media is of particular concern. Self-inflicted death is a compelling story, but depending on how that story is told, especially with children, depictions in the media can increase a phenomenon known as "suicide contagionopens in new window." A child struggling with depression or other issues can actually be inspired by these accounts to attempt suicide.
Suicidologists are working hard to get news of best practices out to members of the media. Ackerman works with journalism students and practitioners through the E.W. Scripps School of Journalism at the University of Ohio in Athens on minimizing the sensational aspects of their reporting.
Like many others in his field, Ackerman was dismayed by the popular recent Netflix series, 13 Reasons Why, based on a 2007 young adult novel of the same name. The series portrayed the aftermath of the suicide of a teenaged girl, Hannah, who was bullied, sexually assaulted and betrayed by supposed friends. Ackerman was especially alarmed that Hannah's suicide was shown in "shockingly graphic detail," and wrote a blog postopens in new window laying out his objections to 13 Reasons Why that became NCH's most-read post ever.
"Exposure to graphic, sensationalized, highly detailed, or simplified portrayals of suicide can result in copycat suicide attempts and deaths by suicide, particularly in teens and young adults," Ackerman wrote in that post.
But that doesn't mean people shouldn't talk about suicide, he says. Straight talk on the subject can bring its causes into the light, and encourage children (and adults) who may have been feeling that they are a burden on their family, or that life is not worth living, to hear other, more positive narratives and get the help they need climbing out of the darkness.
Ackerman is excited about NCH's "On Our Sleeves"opens in new window campaign to get children (and others) talking about mental illness, half of which presents by age 14. In 2020, NCH plans to open the country's largest behavioral health treatment and research centeropens in new window devoted to children and adolescents.
Originally from Maryland, Ackerman did his graduate work at the University of Delaware in Newark, and a postdoctoral fellowship at the University of Maryland School of Medicine in Baltimore, on the effects on children of prenatal drug exposure. He first went to Columbus 11 years ago when his wife, Claire Ackerman, a pediatric psychologist, got an internship there. From 2008 to 2015, he saw patients as part of the Mood and Anxiety Program at NCH, and served as child clinical psychology fellowship training director. Claire Ackerman now works providing behavioral health support in an integrated primary care practice.
Ackerman says he is grateful for his professional training and experience, which has given him a skill set he says includes a sure grasp of data, as well as understandings of the emotional lives of children, the way the brain functions, the influence of family systems and how to build relationships within a community.
"Having a strong foundation in clinical psychology has allowed me to work in a less traditional area in a way that is incredibly rewarding for me, and that I feel makes a difference," he says.
Ackerman is a member of Div. 53 (Society of Clinical Child and Adolescent Psychology). He also works with the Zero Suicide Institute to develop best practices around suicide training, screening, assessment, treatment, follow-up and quality improvement, and serves on committees of the American Association of Suicidology. He also helps train NCH's interns and fellows.
Ackerman says he leverages the good he can do in his job against the difficulty of working in a field where any failure can mean a child's death.
"I spend a lot of time with my family and self-care. Also, suicide prevention people are one of the best groups you could find. There's just such a huge need out there," he says.
