TORONTO — There’s a word you’ll never hear in a new program to help children cope with troubling emotions: Suicide.
It’s delicate, balancing the need for helpful mental health messages without mentioning the act, which has a tendency to spread like a terrible contagion.
In Canada in 2009, there were 25 reported deaths by suicide among children aged 10 to 14.
Every year in the U.S., about 12,000 children ages 5 to 14 are admitted to hospital psychiatric units for suicidal behaviour.
And one more: 8 per cent of young people attempt suicide.
Those appalling numbers were the background as the Hospital for Sick Children launched a new program this week — an interactive video game — to help children express their emotions. Being able to speak about feelings is a key part of mental health.
The video is made for children ages 7 to 12. Rather than talking about suicide, the story set in space allows kids to choose different ways of responding to feelings such as being sad or left out.
It seems a very young age to be worrying about suicide, but doctors say prevention and identifying risk early on is critical.
“This age group is such an important one,” says Dr. Peter Szatmari, chief of child and mental health at Sick Kids. “If the peak vulnerability is adolescence and youth, the prevention opportunities are in childhood.”
The launch came on World Suicide Prevention Day, the first time Sick Kids has observed the event.
The tragic thing, Szatmari said, “is that suicide is so utterly preventable.”
‘Intervention for prevention’
Sitting in the front row was Fran Brown. She is the reason the video, called Monarch’s Mission, exists. While the room was full of caring people who want to reduce the risk of suicide among the young, it’s fair to say no one may have felt the need more deeply than Brown.
Her daughter Lisa killed herself Oct. 14, 2004. It seems Lisa wasn’t able to talk about her feelings with those closest to her.
Despite her grief, Brown set to work trying to understand suicide. Although Lisa was 41 when she died, long past childhood, Brown came to see the importance of intervening and setting good mental health habits at an early age. She calls it “intervention for prevention.”
When it was her turn to speak at the launch, Brown said our culture tends to deny emotions except happy ones.
“I want children to feel comfortable expressing and not suppressing their emotions, specifically anger and sadness,” she says.
The crowd didn’t stir as she spoke. Her daughter, whose graduation photograph was on a screen behind her mother, had kept her own need for help a secret. “She hid her illness from everyone.”
Lisa, her mother concluded, was ashamed of being depressed.
“I have vowed to be the voice Lisa didn’t have. I will never be silenced by the stigma that silenced my daughter.”
Right from the start, at Lisa’s funeral, Brown didn’t want to conceal the fact that her daughter had serious depression.
“I said, ‘I want the honesty to start now,’ ” she says in an interview. “I want no part of a coverup.”
Brown and her husband Dan, who works in real estate, raised Lisa and her older brother, Paul, in Waterloo. After their daughter died, they started the Lisa Brown Charitable Foundation and used the funds, then mostly their own, to send kids with emotional difficulties to therapeutic camp.
But Fran Brown was frustrated and wanted her little foundation to help more young people. She turned to her husband, “Danny. I’m calling the president of the SickKids Foundation.”
Did she know Ted Garrard?
“Of course not.”
The couple met Garrard and said they wanted to fund a program on children’s mental health. But what? A speakers’ bureau? Pamphlets? Something online? Fran Brown did more research, interviewed doctors and educators and, hands down, she knew she wanted an interactive and online program in children’s own language. Kids talking to kids and parents listening and learning to ask, “How do you feel?”
She met Dr. Johanne Roberge, director of psychiatry emergency and crisis service at Sick Kids, and talked about her idea. What about something to help kids talk about their feelings, Brown asked. The doctor’s eyes lit up. “Yes, yes, yes.”
It’s more difficult for kids with emotional difficulties to come up with solutions; they struggle more than others to be able to say what’s going on, says Roberge.
Szatmari says current thinking is that behaviour is driven by the complex interplay of cognition and emotion. By bringing emotions into conscious awareness, you can challenge them and apply reason to them.
“That’s why the video game is cool. It’s the pairing of expressing and thinking about your emotions. I can problem-solve this. I can deal with this.”
So you failed a test, he says. Is it really the worst thing in the world?
“People have to be shown this as a model and showing it in a video game is a really effective way for younger children.”
The interactive story — in his travels, a space explorer finds creatures dealing with differing emotions — will be accessible to many children on About Kids Health, the Sick Kids website for families and patients. It has about 3,000 articles on subjects from juvenile diabetes to ADHD and will have about six million visits this year.
Emerging research shows that kids do learn and can change behaviour from technology such as videos, says psychologist Patrick McGrath.
It’s not as effective as work with a trained professional, but modelling is a powerful tool, says McGrath, vice-president of research and innovation at IWK Health Centre in Halifax. “Modelling is one of the most effective ways of teaching. The way you have the most influence is not what you tell them, but what you do.”
Fran Brown says she knows she was a “pain” pushing educators and doctors hard about her ideas on intervention. She wants to go further and hopes the video game becomes a teaching tool in schools.
Her own daughter, with the dark curly hair, seemed a happy child. Her parents didn’t know of the turmoil inside. She was “always kind, always giving.”
In her late 30s, when Lisa lost the temp jobs that she had worked at since graduating from Western University, her mother begged her to talk. “Honey, are you depressed? Tell me.”
But she’d say, “Nothing’s wrong. Everything’s all right.”
“Lisa, honey, I’m so worried. Together, let’s see a psychiatrist, let’s go together.”
But Lisa wanted none of it. What had been privacy about her life, seemed from her mother’s view, to become a paranoia. Her family knew little about her private life — not even whether she had a boyfriend. She began to lose her temper. “It was out of character.”
Her parents later learned that Lisa had been on antidepressants. A doctor’s note said she did not appear to be suicidal.
It’s painful, still, for Fran Brown. Friends have asked, “How could you not have known?”
“I should have. I could have. What kind of mother am I?”
It doesn’t come naturally, all the writing of letters and speeches, and pushing people to help the family’s foundation. Yet, she perseveres, even if it means pestering people. She is now Lisa’s voice, speaking for those who, as a family friend says, “cannot say they are hurting.”
“I had to live to see this,” says Fran Brown. “I am not a young woman. No doubt, on my tombstone, it will say: ‘At least she tried.’ ”