Expert Advises Santa Barbara on ‘Suicide Spike’

Since last October, Dr. Robert Macy, an internationally recognized expert in community trauma treatment and prevention, has been counseling agencies that respond to suicide in Santa Barbara. He spoke with The Independent on Friday evening, February 19, halfway through the Post Traumatic Stress Management Basic Training seminar he was conducting in Victoria Hall, attended by 145 representatives from dozens of local agencies. The intensive workshop, put on by The Glendon Association, was meant to train individuals and organizations to handle what has been described by many officials as a dramatic increase in teen suicides over the past year.

How has the training been going, and how has it been similar or different from other seminars you’ve conducted?

There’s an extraordinary ethno-cultural cross-section here and also people from different disciplines and different experiences. But they’re all hugely committed. They’re working really hard. I mean, we’re doing about seven days of training in three days.

Specifically, with reference to either homicide or suicide clustering, we always try to get a community to gather a training pool that’s cross-sectional with respect to gender, age, ethno-cultural background, and different functions individuals fill in the community (law enforcement, education, public mental health). The size here is somewhat rare. In larger scale disasters we’ll work with 150-200 people, or we may train a whole school system. Usually we’re training more like 35-85 people, so this is a wonderful exception.

The community has kicked ass. I never tell a community exactly what to do because they need to customize [their plan of action]. But whatever I said, they figured out how to customize the plan and do it. Santa Barbara went nuts in a beautiful way. We had short intervals and pretty high mortality [of suicides] and they just wiped that out. People literally just started walking around neighborhoods and started talking to people around wellness and resiliency frames. I’m sure those grass roots movements helped to stem the tide. They basically created an army and kicked butt. It’s been an honor to work with them.

How did you become involved in Santa Barbara? Who were you approached by?

Dr. Lisa Firestone from the Glendon Association had reached out to Dr. Madelyn Gould in Columbia, who is a world expert on clustering. Lisa talked to her about what was happening in Santa Barbara, and Madelyn told her to give me a shout because I’m the clinical, go-to, on-the-ground guy. So I started a conversation with Lisa and then she brought me into the core group. We actually started talking in late October and did a lot of triage work on the phone before I got here in December.

If you could, help me work through some of these statistics that have been thrown around. I know the county has reported a spike in the last year — of 60 suicides compared to 34 the year before — but how many of them were teens? Why the emphasis on the prevention of specifically teen suicides?

Let me grab my Santa Barbara folder and check out the epidemiology report. [Pause] Just saying numbers and using percentages, frankly, is inaccurate and you can get called on it, so I want to be really careful here. I know that four youths, all under 21, committed suicide in a 5-month period, but it’s also important to remember that the time-span makes a difference. I’ve been looking at stats every week — suicide calls and crisis calls. The problem with percentages (for instance if you say that going from 34 suicides in a year to 60 is nearly double the rate) is that they don’t tell the whole story, and it can get really dicey. You have to use a test and look at age-breaks and at least a four-year baseline of data. What [The Independent] should be able to do, and what the public deserves to know, is specifically attempts and completions. That’s not going to cause harm. You want to make sure you’re not inventing a number (like suicides have doubled in a year) when in fact the way epidemiologists would do this, is look at a four-year period and look at the age breaks.

[Editor’s Note: The Independent has yet to obtain statistics specific to teen suicides over the past four years as the person who has those numbers, Sgt. Gregg Weitzman of the County Coroner’s Office, is out of town. Representatives from The Glendon Association were also unable to provide the figures.]

So the 34 to 60 jump, I believe, is an age range of 12-65 years old. And the majority of those, the way I understand it, were older, middle-aged males. You also have to ask whether the medical examiner ruled some of the ones they’re calling suicides, medically, as an overdose, because you really can’t call those suicides even though lots of people like to. I’m sorry, I just haven’t scrubbed the data to be able to tell you that that’s definitely the case. I know it’s four [youth suicides], and I got called right after number three and did a quick assessment of a lot of the numbers.

I immediately discovered it was an outlier clustering because you normally don’t have all Latino boys (which is not normal in terms of epidemiology) from the same gang committing suicide. So there was some oddness there but also, I thought, some further contagion mechanisms. I said we’d just better start putting in place contagion containment because it sounds really lethal, which in fact it was.

So you’re saying that these youths were in fact all from the same gang?

Yeah, they were all from the same gang.

Who told you that?

I went into the streets. So I got lots of street data to back that up.

The County Coroner’s office (which is part of the Sheriff’s Department) had taken exception earlier this year with initial reports that the youths were somehow affiliated. The office said that the victims did not know each other and were not connected.

I think there’s multiple points of entry here. I would have to say — and I’m not trying to be coy — from the Sheriff’s Department’s vantage point, they are correct. The street would look at it a little bit differently. Neither one has to be right or wrong. Let’s put it this way, though: The fact that the four were not from different sides of the city is morbidly interesting. They were affiliated.

Because at first I thought, and I had a hope, that this could be generated by gang violence between two opposing gangs. But in fact that doesn’t look to be the case, although the violence was certainly a contributing factor. You’re calling to find out what the hell is actually happening, why is the training here? Is it really needed? I think it was very much needed.

Talk to me about how media reports suicide. What do you think journalists in general do right or wrong when writing about suicides?

I think in general — and I’m not throwing you a rose here — local, independent papers tend to do it right. In other words, they’re willing to follow the Center for Disease Control and Prevention guidelines on how you publish suicide events. I know from the journalist’s point of view (because I’ve worked with journalists around war trauma, and I have huge respect for the industry and journalists in general), that you got the sell the paper. Suicide can be a really big event. It’s a really great seller if you position it properly. But by positioning properly, which usually means on the front page or near the front page, and talking about the methodology and treating it like a big event, we know that in a cluster environment that it is a known, scientifically proven contagion factor. It increases suicidal behavior in the community where the paper publishes it that way.

Journalists ran their own studies showing that that wasn’t true. (That was maybe 11 or 12 years ago.) So there were about 184 studies showing that there was in fact a direct correlation, and I think 17 studies showing that there wasn’t. When you take apart the press studies, you can see that they’re not that rigorously designed.

There’s a joke among some of the big shots. The guy that owns the New York Times and the Boston Globe, who has screwed me over specifically a number of times, always says, “We’ll follow the guidelines, Robert. Show us what they are.” I go over them in detail, and they take every guideline and do the exact opposite to get the most sensationalism, which is in fact the case. So, I haven’t been able to trust the national press because those guys say they’re trying to help but they go about making it grandiose. And it’s dangerous for the community.

It’s one of these tricky things—the First Amendment is a pretty big deal to me too—so I’m hesitant to talk to press because there’s always the issue. But I feel comfortable in this case because I’ve been here for a while, I know the numbers, we know there’s been a significant decrease in risk behaviors among the target populations we were most worried about. And many of the contagion containment protocols are in place.

I think the press in general has become more sensitive and responsible and responsive to those of us like myself and Dr. Gould who aren’t trying to stop publications. We’re trying to work with journalists to make sure we get this right, because you really have to look at that three- to four-year database.

So before you came to town and started organizing the seminar, you looked at the three- to four-year statistics and you saw a worrisome trend among teens? Is that accurate?

Yes, among the kids, I did. You look at two things: The number of incidences and you look at the index case. Who, where, and what was the first case. Once you’ve penned the first case, you look at the time intervals between one, two, three, and four. So we look at number of incidences, time intervals between incidences, then geographic and socio-emotional affiliations. So if they’re all in the same zip code or within three blocks of the same zip code, if all four are somehow affiliated with any gang activity at all, or with specific gangs, or specific parts of the city, we have further concern. It’s kind of the same as how an infectious disease would spread. But it’s harder to measure because its socio-emotional and psycho-social.

By the way, with regard to the affinity of the relationship, the kids don’t have to know each other to have the contagion continue. They don’t have to have ever spoken to each other. That’s actually not how it works. Kids don’t copy the act of suicide, they copy the attributes of the line of precedents.

How did you get into this line of work? I know you have an extensive background with the Center for Disaster Resilience and the Boston Children’s foundation, but before that involvement, how did you become interested in and attuned in this kind of work you’re doing?

I was originally in school in Oregon where I studied to be an actor and a director in the theater. I did that work for a while and also learned mime. I then went to Martha’s Vineyard — after I did a lot of theater training and martial arts and dance training — to take care of my grandmother who was dying. I just needed to make money so I started doing birthday parties and some of the parents asked me to teach them mime. I started giving private lessons and they’d start crying and telling me all of their personal problems. I thought, “What the heck is going on here?”

I told one of my friends one day and he said, “You idiot, you’re probably doing dance therapy and you don’t even know it.” Long story short, my first Master’s degree was in clinical psych degree focusing on dance therapy. At that point I was working with chronic schizophrenics and people who were pretty lethal to themselves. I got really interested in the concept of trauma: What makes people get into a corner like that?

I started studying and ended up at the Harvard Medical School’s trauma center and I got really interested in dealing with people in trauma and talking and calming them down. I got into the neuroscience lab in Harvard and started looking at the neural behavioral substrates to trauma. Eventually I started working for Medicaid in Massachusetts with the high-risk case loads — 127 intensive clinical managed people from Medicaid that were all traumatized and suicidal. So suicide kept coming up along with the trauma.

I did that for two years, then left and ran a trauma-response program with a grant from the state. That was in 1994. Two months into it, I went to respond to a homicide in South Boston and went to help the kids out who had witnessed it. I noticed that this one development just literally had kids hanging out the doorway with needles in their arms. It was like a movie. So I took a chance and started walking around the hallways and talking to people. The place was called Old Colony.

I blew the whistle and called my boss who grew up there. He said, “Robert, we can’t talk about it.” I said, “Jim, you gotta talk about this. There are kids lying on the street here. This is highly, highly lethal.” I found out that two kids had already suicided, but at that point I didn’t even know what a suicide cluster was. Mental Health turned around and started investigating, and next thing you know I’m being put in charge of one of the largest clusters in United States’ history: 11 boys dying in nine months within two blocks of one zip code.

So I did what I knew to do best in the streets, because I’m kind of a community organizer and a clinician and I’m good with groups. I found out about Madelyn Gould [the expert on suicide clustering], and called her and she started tutoring me. I looked up the CDC protocol from 1988 and realized it wasn’t going to do any good, so I used it as a guideline but rewrote some stuff and started doing the work in the community. The next thing you know, I had figured out how to do it with a bunch of help mainly from the kids I had worked with, the survivors. Once I did that, which took two years, I was somehow a cluster expert. The next person that called, I did that one, and then that one; and it just kind of kept going. All because of accidental tourism.

How many clusters have you investigated?

Santa Barbara was number 14 since 1995. I’ve done consulting on probably another 20.

Have you experienced any trauma in your personal life that you were forced to work through?

I am one lucky son-of-a-gun. I’ve never had a personal experience with suicide, and I’ve had a very, very lucky life.

For me, it’s about the underdog. I grew up in the South in the 1960s and there was a lot of racism. I naturally started affiliating with the underdog and hating bullies. And a lot of trauma is about people getting bullied, so that’s my guess of how I got into this work.