Advocates call for safer internet for northeast Pa.’s youth
There’s a place on the internet for just about everything.
For kids and teens, it’s where they communicate with friends, complete schoolwork and find entertainment, especially during the disruption of the COVID-19 pandemic.
And it’s also where, in a panicked, spiraling moment, young people might turn to for information about how to die.
The instructions are easy to find: Type in “how to tie a noose” on YouTube, and the results fill the screen.
Some of the videos require users to sign in due to age restrictions, but some can be viewed anonymously. The phone number for the National Suicide Prevention Lifeline appears above the results, and on some individual video pages, but not on all of them.
The videos shouldn’t be on YouTube at all, said U.S. Rep. Susan Wild, a Democrat representing Pennsylvania’s 7th District, in a call earlier this month with mental health experts and advocates.
Mental health has been a key priority for Wild, whose partner died by suicide in 2019.
In 2020, she led a group of two dozen colleagues in writing to YouTube to urge more prominent promotion of resources, pop-up warnings, mental health prompts and “lengthy educational introductory videos that cannot be skipped.”
Those measures would have been “simple, common sense steps that would put more time between a person’s suicide impulse and the viewing of content that may assist in a suicide attempt,” Wild said.
But now, with suicide attempts rising, those changes wouldn’t be enough, she said. Since the letter was sent, “the mental health crisis that our kids are facing has become so dire that we need bolder action. We need these videos taken down for good.”
Growing concern over youth mental health
Wild’s call to action came on Safer Internet Day, but it also fits within a pattern of growing national concern about youth mental health.
A poll conducted earlier this month found that among parents, 80% “are concerned about the mental health status of their own children.”
Data backs up that concern: “Recent research covering 80,000 youth globally found that depressive and anxiety symptoms doubled during the pandemic, with 25% of youth experiencing depressive symptoms and 20% experiencing anxiety symptoms,” according to an advisory issued by U.S. Surgeon General Vivek Murthy in December 2021.
A 2021 report from the Centers for Disease Control and Prevention shows that while emergency department visits for suspected suicide attempts declined among young people in the early weeks of the COVID-19 pandemic, these visits later surpassed 2019 levels.
This was particularly true for teenage girls. In a four-week period in February and March of 2021, emergency department visits for suspected suicide attempts by 12- to 17-year-old girls were up 50.6% compared to the same time in 2019, according to the CDC’s analysis of data from a majority of U.S. emergency departments.
While there is an increase in suicide attempts, Murthy’s advisory and the CDC report also noted that there does not seem to be a correspondingly sharp rise in suicides.
“Importantly, although this report found increases in ED visits for suspected suicide attempts among adolescent females during 2020 and early 2021, this does not mean that suicide deaths have increased,” the CDC said, adding that provisional mortality data showed “no significant change” in the suicide rate among 15- to 24-year-olds when comparing July to September of 2019 to the same months in 2020.
The issue has gained attention not only from Wild but from Congress more broadly, with a Senate committee and a House subcommittee each holding hearings on mental health last week.
The Senate also passed the Dr. Lorna Breen Health Care Provider Protection Act, legislation sponsored by Wild and named for a New York City emergency room doctor who took her own life in April 2020. The bill, which previously passed in the House, is intended to improve the mental health of health care providers.
Marie Onukiavage, executive director of the northeast Pennsylvania affiliate of the National Alliance on Mental Illness, said that while she hadn’t previously been familiar with the noose videos on YouTube, “there’s always harmful information out there,” and trying to find and address it all “can be an uphill battle.”
NAMI focuses on what it knows best: Education, prevention and advocacy “for easier access to appropriate services.”
Signs to look for include changes in behavior, social isolation and withdrawal from activities, talking about death, expressing helplessness or hopelessness, and giving away prized possessions, Onukiavage said.
Additionally, “Changes in sleep, appetite, and energy level (either too little or too much) are also very common,” said Dr. Courtney Chellew, who works in child and adolescent psychiatry at Lehigh Valley Health Network. “More severe depression can make it challenging to complete everyday tasks like showering, changing clothes, and brushing teeth.”
Although children who need mental health care often face long waits for services, families can start by speaking with a pediatrician while waiting, Onukiavage said. “At the very least, you’ll get some medical oversight of the situation.”
She also advised having non-judgmental conversations with the child. “Encourage them to talk about what they’re feeling, but don’t force them to talk about what they’re feeling,” she said.
Crucially, parents and caregivers shouldn’t avoid the conversation for fear of planting the idea of suicide.
“Very often, it’s something that somebody thinks about alone,” keeping it to themselves for a variety of reasons such as dread, stigma, fear and shame, Onukiavage said. “And to have somebody ask it in a calm, supportive manner can be very helpful.”
She advised approaching the topic straightforwardly: “Are you thinking about suicide? Do you want to die?”
If a person says no, don’t end the conversation, Onukiavage said. Let them know why you’re asking, what warning signs you’ve noticed.
Additionally, Kathy Wallace of the Northeast Suicide Prevention Initiative recommended consulting the Society for the Prevention of Teen Suicide and the Suicide Prevention Resource Center on how to have these conversations with children.
Onukiavage and Chellew both noted the importance of restricting access to potential suicide methods such as guns and medication.
“Unfortunately, suicide can be an impulsive act. The best way to protect against these impulsive decisions are to create a safe environment at home,” Chellew said. “I believe it’s best practice for everyone to keep medications (prescription and non-prescription) locked in a lock box, but especially parents of depressed children should lock up medication. Firearms should be secured safety – with a gun safe and/or trigger guard. Ammunition should be stored separately.”
Chellew also recommended monitoring and limiting electronic devices and media.
“I applaud their efforts,” Onukiavage said of the fight against YouTube’s noose videos.
But ultimately, she wants to see a world where that push isn’t even necessary.
“I’d like to see a place where our children — anyone, for that matter — isn’t searching the internet for ways to take their own life,” Onukiavage said.
If you are having thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255, or text the Crisis Text Line by sending “HOME” to 741741.
For NAMI NEPA resources, including a support meeting calendar, go to naminepa.org. For county-by-county links to suicide prevention task forces in Pennsylvania, go to preventsuicidepa.org/task-force-county-init.
Kathryne Rubright is a reporter covering the environment, northeast Pa. politics, and local news. She is based at the Pocono Record. Reach her at email@example.com.