In July 2016, the Utah Department of Health and Human Services reported that the suicide rate for children aged 10 to 17 in Utah had tripled since 2007 (Utah Department of Health and Human Services, 2016). Utah adolescents were committing suicide at a rate twice the national average and suicide had surpassed accidental injury as the primary cause of teen death in Utah (UDHHS, 2016). Utah’s rate of increase for teen suicide was nearly four times the National average between 2011 and 2015 (Ramseth, 2017; UDHHS, 2017). In a flurry of media coverage, spokespersons for the UDHHS suggested several possible causal links, including Utah’s altitude, its high rate of residential mobility and of gun ownership, and to the State’s “rugged mentality of self-reliance” (Price, 2016).

 

Utah’s problems have gained National attention.  In November 2017, the National Substance Abuse and Mental Health Administration  (SAMHA) sent a team of investigators to Utah to work collaboratively with the Utah Division of Substance Abuse and Mental Health in an effort to unmask the causes of Utah’s high rates of teen and young adult suicide. Utah universities, schools, community and governmental organizations are keenly aware of the problems but the root causes of the crisis remain elusive.

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Statistics on suicide rates present only one part of a complex and troubling mental health picture of Utah adolescents. Data also suggests a growth in other markers of mental illness. The Prevention Needs Assessment, a 135-question survey, developed by research group Bach Harrison in collaboration with the Utah State Board of Education, is administered bi-annually to Utah school children in grades 6, 8, 10, and 12. The testing is a part of the Utah State Board of Education (USBE) Student Health and Risk Prevention initiative. Survey data shows significant increase in multiple markers of mental illness over the past ten years. In the 2017 survey, 67% of Utah teens showed moderate to severe depressive symptoms; 29.4% of 10th and 12th grade respondents reported feeling “sad or hopeless” to the point of being unable to participate in normal activities; 19.4% reported seriously considering attempting suicide; and 7% reported actually attempting suicide one or more times (Bach Harrison, 2017).  This data paints a bleak picture of the inner life of Utah teens.

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The Utah Department of Health and Human Services, Substances and Mental Health Division (SMHD) reports that, of the 20% of Utah youth who need mental health services, fewer than one in five receive that help (Thomas, 2016). Much of the Department of Health’s and the Utah State Board of Education’s intervention focus has been on drug and alcohol abuse prevention. Historically, drugs and alcohol have been seen as culprits of teen trouble. But Prevention Needs Assessment data actually shows a marked decrease in substance abuse among Utah teens over the past ten years, other than for e-cigarette and opioid use (Bach Harrison, 2017). It would appear, on the surface, that the growing mental health crisis is not causally linked to drug and alcohol use—and yet the substance abuse metric remains a centerpiece of most survey studies administered regularly to Utah youth. 

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Prevention Needs Assessment data is especially troubling given that the dramatic increase in adolescent depression, anxiety and suicidal ideation has happened in parallel with substantial statewide efforts at resolving the crisis. Over the past decade, Utah’s governmental and mental health agencies have implemented a wide array of supports and interventions to battle teen suicide, mental health pathology, and anti-social behaviors, including task forces, trainings, crisis lines, and connections with community mental health organizations.

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Limitations of Current Approaches to Mental Health Research and Support

 

Most efforts to understand the adolescent mental health crisis in Utah are focused on suicide prevention, which is understandable in a state that has garnered national attention for consistently leading the nation in teen suicide deaths per capita (Price, 2016). But assessing the effectiveness of prevention efforts is problematic at best. These efforts have not yet begun to curtail the rate of teen suicide (Bach Harrison, 2017). Student self-report of depression, suicidal ideation and anxiety continues to increase and schools continue to feel a need for more adequate and effective mental health resources (Hargave, 2017). Although every effort at preventing loss of life is important, it’s crucial that we ask hard questions about the effectiveness of programs. Is it possible that the current focus on targeted suicide interventions and postvention may be diverting research efforts from exploring the root causes of the mental health crisis in Utah schools? In being laser focused on the pathology of suicide, are we failing to consider more holistic protective factors that might have a broader impact on adolescent mental health—factors such as, school climate, programs & curriculum? As we implement peer-to-peer prevention programs, are we also failing to strengthen authentic peer and student/adult relationships in schools?  In placing a spotlight on suicide prevention, are we missing the silent sufferers who do not manifest illness or express a need for help, but whose quality of life and academic achievement are compromised because of anxiety and depression?  Even moderate depression and anxiety affect quality of life, academic achievement, and ultimately, the future success and happiness of young people. It’s essential to think beyond emergency referrals and crisis interventions and find ways for educators to cast a wider net of support for the well being of all students.

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This study will be an examination of how unique sociocultural conditions in Utah might be contributing to Utah State’s adolescent mental health crisis. It will explore how Utah’s educators and policy makers might actually be complicit in exacerbating the crisis.  It assumes that we must explore causes and solutions that look beyond  those currently being examined. While suicide postvention studies, peer support programs, and mental health crisis counseling might be essential practices for supporting students in crisis, these measures have done little to stem the tide of anxious, depressive and suicidal feelings that too many Utah teens are experiencing. This study begins with the assumption that we must critically examine practices in our classrooms and schools that might be harming students, and that we must then imagine and implement programs and practices more systemically to support student mental/emotional health.