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Gay, Lesbian, Bisexual, Transgender Youth Suicide

By Warren J. Blumenfeld & Laurie Lindop
Reprinted with permission.

"Someday, maybe, there will exist a well-informed, well-considered, and yet fervent public conviction that the most deadly of all possible sins is the mutilation of a child's spirit." Erik Erikson

"This issue is not about a 'different' way of life; it is about life itself. I know that every teacher and every parent in this Commonwealth fundamentally agrees that no young person -- gay or straight -- should be driven to take her or his life because of isolation and abuse. This is a tragedy we must all work together to prevent. We can take the first step toward ending gay youth suicide by creating an atmosphere of dignity and respect for these young people in our schools. Governor William F. Weld, speaking at a Gay and Lesbian Youth Commission Teacher Training, Arlington Street Church, June 30, 1993.


Overall Youth Suicides

Suicide among adolescents is a national and statewide tragedy. The Massachusetts Department of Education asked more than 3,000 students in 1994 to answer questions anonymously and found that 10 percent had attempted suicide compared with 6 percent in 1990, 20 percent "made plans" to commit suicide compared with 14 percent in 1990. 3.4 percent required medical treatment as a result of a suicide attempt. (1)

Adolescent suicide has increased threefold in the last 10 years, making it the second most frequent cause of death among youths aged 15-24 (10 per 100,000 deaths per year). (2) The incidence of suicide among adolescents between the ages of 15 and 19 had jumped from 2.7 per 100,000 in 1950 to 9.3 in 1982. The incidence of youth suicide stands at 11.3 per 100,000 today. It is estimated that suicide attempts are 40 to 100 times more common than completed suicides. (3) An additional 500,000 youths of all sexual orientations attempt suicide annually. (4)


Suicides among Gay, Lesbian, Bisexual, & Transgender Youth

In 1989, the United States Department of Health and Human Services (HHS) issued its "Report on the Secretary's Task Force on Youth Suicide," which found that "A majority of suicide attempts by homosexuals occur during their youth, and gay youth are 2 to 3 times more likely to attempt suicide than other young people. They may comprise up to 30 percent of (the estimated 5,000) completed youth suicides annually. (5) The report recommended that "mental health and youth service agencies can provide acceptance and support for young homosexuals, train their personnel on gay issues, and provide appropriate gay adult role models; schools can protect gay youth from abuse from their peers and provide accurate information about homosexuality in health curricula; families should accept their child and work toward educating themselves about the development and nature of homosexuality"

According to Kevin Berrill, Director of the Anti-Violence Project of the National Gay and Lesbian Task Force at the time of the report,s release stated, "The increased risk of suicide facing these youth is linked to growing up in a society that teaches them to hide and to hate themselves. We welcome this report and hope it will lead to action that will save lives."

Initially, however, the report was suppressed by the Bush administration under pressure from right-wing groups and by conservatives in Congress. After the findings, William Dannemeyer, who was at the time a conservative Republican member of the U.S. House of Representatives from California, called for then-president Bush to "dismiss from public service all persons still employed who concocted this homosexual pledge of allegiance and sealed the lid on these misjudgments for good." HHS Secretary Louis Sullivan wrote in a letter to Dannemeyer that the study "undermined the institution of the family." (6)

The findings of the report were leaked to the press and finally released. Other studies confirm these findings. Gary Remafedi, Assistant Professor of Pediatrics, University of Minnesota, and author of Death by Denial: Studies of Attempted and Completed Suicide in Gay and Lesbian and Bisexual Youth, found in a 1991 study of 150 gay and lesbian youths in Minneapolis, more than 30% said they had attempted suicide at least once as a teenager.

The youths who are at the greatest risk for suicide are the ones who are least likely to reveal their sexual orientation to anyone. Suicide may be a way of making sure that no one ever knows. It's homophobia that's killing these kids. (7)

Remafedi confirmed a 30% suicide rate among gay and bisexual youth, and also found that young men with more "feminine gender role characteristics" and those who recognized their same-sex orientation at an early age and acted on those sexual feelings seem to face the highest risk of self-destructive behavior. This study also documents an unusually high relationship between homosexuality and sexual abuse, drug abuse, homelessness, prostitution, feelings of isolation, family problems, and school difficulties. Thirty percent of these subjects reported at least one suicide attempt, and almost half of the attempters reported more than one attempt. The mean age in this sample at the time of the suicide attempts was 15 1/2 years. Ingestion of prescription and/or nonprescription drugs and self-laceration accounted for 80% of the attempts. Twenty-one percent of the suicide attempts resulted in medical or psychiatric hospitalization, but almost 3 out of 4 attempts did not receive any medical attention. One-third of the first attempts occurred in the same year that subjects identified their bisexuality or homosexuality, and most other attempts happened soon thereafter. Family problems were the most frequently cited reason for attempts. Eighty-five percent of the attempters reported illicit drug use and 22% had undergone chemical dependency treatment. (8)

The earlier a young person is aware of a gay or lesbian orientation, the greater the problems they may face and may be more likely at risk of suicidal feelings and behavior.

Younger gay adolescents may be at the highest risk for dysfunction because of emotional and physical immaturity, unfulfilled developmental needs for identification with a peer group, lack of experience, and dependence on parents unwilling or unable to provide emotional support. Younger gay adolescents are also more likely to abuse substances, drop out of school, be in conflict with the law, undergo psychiatric hospitalization, run away from home, be involved in prostitution, and attempt suicide. (9)

Pollak found that nearly all gay and lesbian suicides occur between the ages of 16 and 21. (10)

The fear of AIDS adds to the anxiety gay youths experience. According to Joyce Hunter, Behavioral Researcher at the New York State Psychiatry Institute's HIV Center in New York City:

Gay teenagers already have so much to deal with that when they find out they are HIV-positive or even that they are going to have to live in a world where HIV is prevalent and a constant threat, they become overwhelmed. It's just another factor that can add to their suicidal thoughts. (11)

Issues of race and gender identity also impact suicide. Thirty-six percent of African-American lesbians compared to 21 percent of white lesbians, and 32 percent of African-American gay males compared to 27 percent of white gay males attempted suicide before age 18. (12)

Transsexuals may be at higher risk than homosexuals and much higher risk than the general population to suicidal behavior. (13) Fifty-three percent of transsexuals surveyed had made suicide attempts. (14)

In February 1992, Massachusetts Governor William F. Weld signed an executive order establishing the Governor's Commission on Gay and Lesbian Youth, taken, in large part over concerns for the high incidence of suicide among gay, lesbian, bisexual and transgender teens.


Other Voices

Additional leaders throughout the country have spoken out on this issue.

Gerald Newberry, Coordinator of Fairfax County, Virginia's family-life education programs talking about why that county expanded family-life education to include issues of homosexuality and homophobia:

We had a moral obligation to combat a devastating trend (gay and lesbian youth suicide). We needed to communicate to our kids that people are different, and that we don't choose our sexual feelings--they choose us. (15)

Charlotte Patterson, Associate Professor of Psychology at the University of Virginia.

We need to create an atmosphere in the schools where everybody is treated with respect. The task of the schools is not to advocate but to educate. Kids should learn there are Jews and Catholics as well as Protestants, and that there are gay and lesbian parents as well as heterosexuals. (16)

Benjamin Ladner, President of the National Faculty, a national organization working for educational reform.

As educators, we've waited too long to respond to the reality of social structures. We have a moral obligation to provide understanding to children about the way things are. We can do it -- in collaboration with the neighborhoods and communities the children live in. But it's our task to provide a base of understanding. We need to own up to this issue. (17)

And Beth Winship, syndicated teen advice newspaper columnist:

Some of the saddest, most hopeless letters I receive are from gay teens. At their age, when sexuality is of paramount importance, doubts about 'inappropriate gender behavior' are excruciating and sometimes the teens are even suicidal. A high price indeed. (18)


Case Studies:

Sharon Bergman

Sharon Bergman, an 18-year old student at Concord Academy -- a private school in a wealthy suburb of Boston -- looks back through her diaries beginning at age ten when peers continually called her "dyke," "lezzie," and "queer," and she counted the times she seriously contemplated ending her life.

Eighteen separate occasions have brought me to hold a shining razor against my wrists, or to empty out a hundred aspirin and count them over and over trying to think of reasons not to swallow them, or to peer out my third-floor dormitory window and try to calculate how I would need to jump to most effectively dash my brains out on the fire escape below.

Fortunately, Sharon sought help before it was too late. I never slashed. I never swallowed. I never jumped. I was much luckier than some people. (19)


Bobby Griffith

Bobby Griffith, however, was not so fortunate. Lacking support from family and friends and being denied valid information in high school for his emerging sexual identity, a few days into his twentieth year, Bobby did a back flip over a highway overpass in the path of a semi-truck and trailer, and was killed instantly. Bobby too kept a diary. At age 16 he wrote:

I can't let anyone find out that I'm not straight. It would be so humiliating. My friends would hate me, I just know it. They might even want to beat me up. Any my family, I've overheard them lots of times talking about gay people. They've said they hate gays, and even God hates gays, too. It really scares me now, when I hear my family talk that way, because now, they are talking about me .... Sometimes I feel like disappearing from the face of the this earth. (20)

Mary Griffith, Bobby's mother, testified at a public hearing on Project 10 (a gay and lesbian school-based support program in Los Angeles) June 23, 1988:

An injustice has been done not only to Bobby but to his family as well. God knows it isn't right that Bobby is not here with his loved ones. Correct education about homosexuality would have prevented this tragedy. There are no words to express the pain and emptiness remaining in the hearts of Bobby's family members, relatives, and friends. We miss his kind and gentle ways, his fun-loving spirit, his laughter. Bobby's hopes and dreams should not have been taken from him, but they were. We can't have Bobby back. Please don't let this happen again. (21)


Nancy Cardell

When JoAnne Cardell's sister, Nancy, told her that she was a lesbian, JoAnne responded judgmentally.

I told Nancy that I thought that gays were disgusting and I couldn't stand the sight of them, and never wanted to be around them again.

Nancy died from an overdose of drugs in an apparent suicide, and JoAnne felt overwhelmed with remorse.

I now have an unbelievable amount of guilt due to the discriminatory comment I made to her years ago.

I can never take back what I said, and this is one of the main reasons I want to do everything I can to help make this world a better place for those who are lesbian, gay, and bisexual....If families and society could only realize the deep scars they are digging every time there is gay bashing, a life could be save. (22)



A mother gives testimony at hearings held in Boston, November 1992, at the Massachusetts State House, to the Governor's Commission for Gay and Lesbian Youth:

My name is Ruth and I've been asked to give testimony regarding my daughter, Opal. She died in April of 1992 from a self-inflicted gunshot wound to the head. Opal was 19 years old when she died. She had told me in the summer of 1991 that she was Lesbian. My daughter was a sophomore at a prestigious, private university in Massachusetts. She had an extremely bright future ahead of her, and was hoping to attend Harvard University and become a district attorney.

While she was home for college break in the summer of 1991, I got a call from one of her friends saying that I should come pick Opal up because "she took drugs." When I went to get her she was extremely high, and babbling. I wanted to take her to the hospital, but she became very agitated and said she would run away, so I took her home instead. On the way home I asked her what was making her do this. I said, "Are you pregnant? Are you a drug addict?" She told me "No," and "to stop guessing because I'd never figure it out." I asked, "Are you Gay?" She didn't respond so I repeated my question and she said "Yes." I asked her if she thought that made any difference in how much I loved her. And I began to tell her that whatever her lifestyle, it didn't matter to me. She was my daughter and I would always love her. I took her home and stayed up all night with her, telling her how much I loved her and that being Lesbian did not make any difference to me. I was very scared for Opal's mental health was this a suicide attempt, or was she just trying to find a way to tell me about her self-discovery? I spoke with a Gay coworker, and he said to see if we could encourage her to get counseling, but if not just to show her our love and caring. Opal adamantly denied counseling, saying "You need it, not me."

I didn't understand; she needed help. I kept pressing her to get counseling, but she would only get angry when I brought up the subject. I didn't know what to do. Should I tell my family/friends? Should I wait for Opal to tell them? I finally accepted the fact that I could not force Opal to get counseling; maybe the drugs were just a way for her to be able to tell me that she was Lesbian. I kept asking her if she needed any help, and she kept saying she was fine. She was 19 years old and very independent. I decided that she would let me know if she needed my assistance.

In August of 1991, I had a baby girl. Opal seemed so happy with her new sister. We would visit Opal at college and she would take the baby everywhere to meet her friends. She called the baby "Peanut" and just seemed to enjoy being with her. But I knew something was bothering Opal. I kept asking her what was wrong. I suspected that she was drinking a lot. She only came home from school about once a month; we spoke more frequently on the phone, but I didn't see her that often. When she was home she kept running up long distance phone bills, and making late night calls. After Opal's death, I found out she was calling her lover, a woman in her mid 20s. From what I have found out, her lover was trying to end their relationship at the time of Opal's death.

I do not blame any one person for Opal's suicide. But I can now see many contributing factors to her decision. When I visited Opal at college during her sophomore year, there were almost always cases of beer in the campus suite. None of her roommates were yet 21. In speaking with other college students, they tell me that everyone drinks on campus, if you don't you're considered weird. Opal's roommates did not know that she was Lesbian. Her closest roommate told me she had asked her outright and Opal had made up an elaborate lie to cover up her sexuality and the letters and late night calls she was also getting at school. After her death, Opal's roommate told me that she was different when she came back to school in September 1991. She didn't want to socialize any more, she stayed in her room in the dark, and slept sometimes for 15 hours a day. None of her roommates had previously told me about these problems. Opal's GPA was 3.3, even better than her first year. I didn't know that she was showing these obvious signs of depression while she was at school. After her death, her roommate told me that they had talked Opal into making an appointment to get counseling when she returned from April school break. When she came home for break in April 1992, she was physically different. She had cut her hair very short; she had gained a lot of weight. She was quiet, but Opal was always a quiet person. She kept a lot to herself. I asked her if anything was wrong, but she kept telling me everything was fine.

The last time I saw her alive was on Wednesday, April 22. I found her body on Friday, April 24. It was the most terrible thing that has ever happened to me. I cannot describe my utter horror and total sadness. My daughter was gone. I couldn't fix her wounds or help her. Imagine the sadness she must have felt to cause her to make this decision. I could not imagine how I could live with the pain I felt, knowing that Opal was so distraught, that she would take her life; and I hadn't put the signs together to think suicide. Even though I realize that suicide was Opal's decision, the guilt that I and my family felt at the time of her death was overwhelming.


Imagine what it's like to grow up Gay/Lesbian in America. When you're little, you feel different, but you don't know what this feeling is all about. Then you get a little older and you hear and use words like "faggot." And then you're an adolescent and you start to realize what this different feeling is, but you cannot talk about it to anyone. Then you're a young adult, and the whole society tells you that the way you feel is abnormal. So, you still can't talk to anyone. and then you fall in love with someone, and just like heterosexual people, you want to shout it from the rooftops and discuss it with someone, and when things aren't going right, you need to talk about that too. But you can't, because you've been taught that what you feel is not right. And you've been taught by society that this love you feel is sinful, and you've learned to hide your true feelings. You've been taught to hate the way you feel, it's "disgusting." So that there's this piece of yourself that you hate and despise, but it's part of who you are. What confusion Opal must have felt. She was such a wonderful young woman, caring and loving. Always helping those who needed help most, and then when she needed help most, she couldn't ask.

The reason that I'm providing this testimony is so that we can look at the contributing factors for Opal's suicide decision: the rampant homophobia in America, starting when children are little. We must stop our children from using words like "faggot," because there will be children who will grow up to be Gay/Lesbian in their play groups. We teach our children not to use racial slurs, but someone's race is easier to discern than their sexuality. We must teach the warning signs of depression and that if someone they know is threatening suicide their friend's safety must take precedence over their loyalty; they must tell a responsible adult. We must teach that alcohol will cause a deeper depression, not alleviate it; alcohol use would not be tolerated in college. School authorities should be vigilant and make sure illegal substances are not in their dorms.

I love my daughter. I know she knew that. I have always had friends from all kinds of backgrounds. I taught Opal to be open and accepting to all people regardless of their race or sexuality or anything that society called different. And even though I taught her these things, it wasn't enough -- society taught her to hate a part of herself. THIS MUST STOP. A wonderful child, with an incredible mind is gone because our society can't accept people who are "different" from the norm. What an awful waste. I will miss my daughter for the rest of my life. I'll never see her beautiful smile or hear her glorious laugh. I'll never see her play with her sister again. All because of hatred and ignorance. I strongly believe that the seeds of hate are sown early in life. Let's replace them with love, understanding, and compassion. We have no choice -- this terrible tragedy will continue to repeat itself and someday it may be your wonderful child who is gone forever. (23)


Intervention Strategies

We interviewed Lee Ann Hoff, Suicidologist and Author of the award-winning book People in Crisis. What follows is that interview plus written materials she has prepared for school-based suicide prevention workshops for peers, teachers, and parents.


Q: What can teachers, parents, and peers do to prevent youth suicides?

Lee Ann Hoff (LAH): What professionals in this field of suicide prevention have said and studied and practiced for dozens of years is, you have to be direct: you have to talk about it, understand what it is about. They must understand the pain and connect it to the underlying issues. What you basically have to do is "uncloset" suicide, which traditionally has been considered a taboo subject in all the major world religions, and throughout the world for the most part. My paradigm came from my work with battered women and I modified it to reflect the experiences gay and lesbian people.


Sexual Identity Crisis Paradigm: How Suicide Happens and Can Be Prevented

Sexual identity crisis origins, manifestations, and outcomes, and the respective functions of crisis management have an interactional relationship. The intertwined circles represent the distance yet interrelated "origins" of crisis and "aids to positive resolution," even though personal manifestations are often similar. The solid line from "origins" to positive resolution illustrates the opportunity for growth and development through crisis; the broken line depicts the potential danger of crisis in the absence of appropriate aids.


Beginnings of Depression and Suicidal Ideas


  1. Situational: experiences same-sex attractions, hears homophobic comments, is verbally harassed, physically attacked, school work declines -- too depressed to study
  2. Social-Cultural: heterosexist values are dominant, individual seen as "deviant," rejected by community, lacks resources
  3. Transition of Adolescence: realizes one is not heterosexual, realizes one is lesbian, gay, or bisexual

Typical Reactions

Feeling depressed (down); shocked, has low self-esteem, misplaced self-hatred, frustrated and confused about what to do, stressed out by keeping one's "secret," frightened by isolation and thoughts of death


Help Available (natural and formal crisis management)

  1. Situational: finds supportive counselor and peer, family and friends get help and support
  2. Social-Cultural: individual joins LGBT organization (for support and social outlet)
  3. Transitional: Survives coming-out process, engages with supportive nurturing peers

Positive Goal: Growth and Development

  1. Survive "coming-out" transition
  2. Feel comfortable with LGBT identity
  3. Free of fear and violence

Negative Resolution to be Prevented


  1. Suicide attempt
  2. Escape into alcohol or other drugs
  3. Violence
  4. Emotional breakdown
  5. Premature death

* * * * *


Q: Some people say, like the topic homosexuality, if you talk about suicide, it will put ideas in students' heads?


LAH: That is a myth that has been undone so long ago; it is absolutely preposterous. There is the delicate thing you have with adolescents around imitative and contagious behavior, but you don't stop suicide by refusing to talk about it. If you keep it under raps, the kids are going to be even more likely to imitate suicidal behavior.



Q: How would you integrate discussions of suicide in the school setting?

LAH: I have created a workshop exercise for peers and for teachers. I open the session with an acknowledgment of the strong feelings most people have about suicide. Recognizing and accepting our own feelings about suicide (such as fear of contagion), and sorting out myths from facts, are important first steps in learning how to help a person in suicidal despair. This activity is designed to help peers and teachers face a "taboo" subject in an atmosphere of trust. As is true of sexual identity, the topic of suicide must be "uncloseted" in a non-judgmental environment.

I explain the following exercise to the peers:

  1. In pairs of two, for a 7-minute period, peers should consider the following question, discuss it with one's partner, and write the responses on a 3 x 5 card: Imagine or remember a situation in which a classmate (family member, or someone else) was very depressed and/or attempted suicide. What feelings did you have at the time, or most likely would surface, on hearing this news?
  2. With the same partner, in another 7-minute period, list at least one reason why young people make suicide attempts or actually kill themselves, and write the reason on another 3 x 5 card.
Discuss for 15 minutes. Then ask the peers to share the results of the first 7-minute discussion, what FEELINGS about suicide came up? Summarize the responses on a large sheet of paper: ask some questions about this exercise:

  • How did it feel to talk openly about suicide
  • Why do most people have such strong feelings about suicide?
  • Where do these strong feelings come from? How can they be understood?
  • What can we do with such feelings?
Explain that such feelings are normal, and that they are related to several historical facts:

  1. The widespread tendency (especially in U.S. mainstream culture) to deny death and shield young people from its reality;
  2. The centuries-long taboo against suicide (all major religions have forbidden suicide on "moral" grounds);
  3. The legacy of punishing survivors (for instance, by denying Christian burial of the person who committed suicide, and thus stigmatizing the relatives).
Explain that we should not be surprised at having strong feelings about suicide when considering such deep-seated cultural values. Emphasize the importance of accepting our own fears and feelings (and discussing them with family or someone else you trust) as a first step in reaching out to people at risk of suicide.

Summarize on another large sheet the results of the second 7-minute discussion: REASONS (why people hurt of kill themselves). From the group's list of REASONS, engage the group in sorting out the myths and facts. Write an "M after each myth, and an "F after each fact. Explain how clinging to the myth that "talking about suicide will put the idea into their heads" can prevent us from communicating a caring message to a suicidal person.

Conclude the 30-minute period by handing out a prepared sheet which summarizes and distinguishes facts from myths about suicide.


Myths and Facts

Myth: People who commit suicide are mentally ill.
Fact: people who commit suicide are usually very depressed or emotionally upset, but this is not the same as being "crazy" or mentally ill.

Myth: Good circumstances -- having a comfortable home, a good job, or being a good student--prevent suicide.
Fact: Suicide cuts across class, race, age, and sexual orientation differences, though its frequency varies among different groups in society. For example, suicide and suicide attempts among gay males and lesbians is considerably higher than among heterosexual youth (due to societal homophobia and heterosexism).

Myth: People who talk about suicide won't commit suicide.
Fact: People who die by suicide almost always talk about suicide first, or give clues and warnings about their intention through their behavior, even though the clues may not be recognized at the time.

Myth: People who threaten suicide cut their wrists, or don't succeed are just looking for attention and are not a risk for suicide.
Fact: The majority of people who succeed in killing themselves have a history of previous suicide attempts. All threats and attempts are "cries for help" and should be taken seriously. Failure to answer a "cry for help" may precipitate another attempt. Anyone desperate enough to make a suicide attempt most surely needs more attention than he or she is currently receiving.

Myth: Talking about suicide to people who are upset will put the idea in their heads.
Fact: Suicide is much too complex a process to occur as a result of a sincere and caring person asking a question about suicidal intent.

Myth: When gay and lesbian people recognize the "sinfulness" of their life, most of them kill themselves.
Fact: Though a significant number of gay and lesbian youth commit suicide or make suicide attempts, they do so most often because of the prejudice, hatred, and sometimes violence they have endured from mainstream society. Just like racial identity or being male or female, sexual orientation is not something a person chooses. When societal attitudes toward gay males, lesbians, and bisexuals change from rejection to acceptance and support, their rates of self-destructive behavior most likely will decrease.

* * * * *

Q: There have been complaints coming from both within the GLBT communities that we over emphasize GLBT youth suicide, and that we must tell more of the positive stories. They say we might be scaring students when we talking about the negative aspects of our lives.

LAH: Everything should be in balance. One shouldn't ever only talk about the negatives, e.g. suicide, substance abuse, etc.. However, that doesn't mean you shouldn't talk about it at all. Even if nobody has made a suicide attempt, you still need to bring it out in the open as something to be prevented, and something to be understood.


Q: Some AIDS educators talk about "passive suicide" in which some young people, due to issues of poor self esteem, will needlessly and purposefully place themselves at increased risk for HIV infection.

LAH: Officially that kind of behavior would not be called "suicidal." It would be called "self destructive." However, any self-destructive behavior is related to the larger issues of self esteem and not caring about one's life, and in this case, the downward spiral into depression. It starts at the top with society blaming the victims, and the next piece is where the victim blames him/herself, and then goes into depression and then potentially suicide. Suicide would be the ultimate self-destructive behavior. Others behaviors would include acting out toward other people, for example, assault or even homicide.

Q: Are there connections between violence prevention and suicide prevention strategies?

LAH: They are very similar in many respects, with the major piece being helping people find other ways to express either their despair or their anger. In the case of suicide, the key dynamic is depression and despair. In the case of violence it's anger and assault. If one is feeling very angry, rather than hurting somebody else, one can do some tension relief activities along the lines of physical exercise and also talking about one's feelings, which is the most important thing. Sharing violent fantasies with another can be a great relief, keeping them from exploding outwardly. It can be very scary for people who have those kinds of fantasies. It comes from fear of loosing control.


Q: Some people argue that violence and suicide are issues only to be discussed by guidance counselors, and not, for example, by classroom teachers or peer counselors. What is your opinion?

LAH: Teachers are front-line workers when it comes to things that have been called "mental health issues." In another sense this is everyone's business and that includes teachers, parents, and peers. I made a distinction between "Level 1 Assessment" (every human being needs to assess this risk for life). "Level 2 Assessment," on the other hand, is a largerpiece which usually specialists do. Everybody needs to at least find out if there is some danger here and what is going on and at the very least to make a sympathetic statement and offer support and understanding, and to try to link the person up with someone who they feel more comfortable with. This is the teacher/counselor link, the peer/counselor link, or the parent/counselor link. No matter who you are, if you suspect a problem, it does no one any good to keep it under raps.

A teacher may get wind that there is a problem in a class paper the student writes. If that teacher suspects what is going on but keeps it to her/himself, and that kid makes a suicide attempt or kills him/herself, how is that teacher going to feel -- terrible.

The crucial point is, just because you open up this subject, it doesn't mean you have to do the whole thing. All you have to do is give the message of caring and concern and link that person with somebody who has more skill and experience. In many instances that may even be enough.


Suicide Assessment Models

Risk Assessment Scales (Lee Ann Hoff)

  1. 1. No Predictable Risk of Suicide Now. No suicidal ideation or history of attempt, has satisfactory social support system, and is in close contact with significant others.
  2. 2. Low Risk of Suicide Now. Person has suicidal ideation with low lethal methods, no history of attempts, or recent serious loss. Has satisfactory support system.
  3. 3. Moderate Risk of Suicide Now. Has suicidal ideation with high lethal method but no plan, or threats. Has plan with low lethal method, history of low lethal attempts.
  4. 4. High Risk of Suicide Now. Has current high lethal plan, obtainable means, history of previous attempts, is unable to communicate with a significant other.
  5. 5. Very High Risk of Suicide Now. Has current high lethal plan with available means, history of suicide attempts, is cut off from resources

Risk Factors in GLBT Youth Suicide, compiled by Paul Gibson, L.I.C.S.W.

General: Awareness or identification of same-sex feelings at a relatively early age, sometimes even acceptance of homosexual orientation. Often conflicts with others related to this orientation, and/or problems in same-sex relationships.

Society: Discrimination/oppression of gays and lesbians by society. Portrayals or representations of homosexuals in the society as self destructive or hurtful to others.

Poor Self Esteem: Internalization of society's notions of LGBTs as sick, self destructive, sinful, spreaders of disease, molesters of children, and pathetic.

Identity Conflicts: Denial of same-sex feelings or orientation. Despair in recognition of same-sex orientation.

Family: Perceived or actual rejection, abuse, harassment of child due to LGBT orientation. Child's feelings of failure to meet parental/societal expectations.

Religion: Child's LGBT orientation seen as incompatible with family's religious beliefs in which youths feel sinful or condemned.

School: Harassed and/or abused by peers (and sometimes faculty and staff). Lack of supportive peers and adults, role models, and accurate information about LGBT life in the classroom.

Social Isolation: Stemming from rejection or fear of rejection by peers and family, social withdrawal, loneliness, and inability to meet others like themselves.

Substance Abuse: Substance use to relieve the pain of oppression and loneliness and to reduce inhibitions of same-sex feelings.

Professional Help: Inability or unwillingness to discuss issues related to same-sex feelings, and/or forced treatment to change LGBT orientation.


Signs of Suicidal Risk, Lee Ann Hoff

  1. Severe Changes in Behavior, Attitudes, School performance.
  2. Giving away prized possessions.
  3. Putting oneself down for the smallest failure.
  4. Extremely upset and depressed over everyday happenings.
  5. Giving a verbal message that could be taken as a "good-bye": "I just can't take it anymore...Something's got to give.
  6. Any action or way of behaving that seems unusual for the person, for example: driving recklessly; eating or drinking more or less than usual; a student with a good academic record quits studying.

Two Basic Principles of Communicating with Upset People (Lee Ann Hoff)

  1. Convey to the person that you understand (or are trying to understand) and care about the pain or other distress the person is going through. For example: "Gee, Nancy, you don't seem much like yourself lately...I missed you in class yesterday.
  2. If you are not sure what's going on but are trying to understand, make a reflective statement and/or ask a concerned open-ended question: "Nancy, you seem really depressed (upset)...What's going on? Why don't we get together after class today and talk?
A practice sometimes used by adult and peer counselors is to ask young people to sign pledges promising to seek out a counselor if they become depressed.


Individual Conferences with Students, Virginia Uribe, Project 10

  1. Find Privacy: If possible, try to find a place where the student can be assured of some privacy. Perhaps a cubicle in the counselor's office or in some other office. Avoid placing yourself in a compromising situation. Don't go off campus. Stay visible to others.
  2. Assure Confidentiality: Within the legal limits, assure the student that what is said will remain confidential.
  3. Maintain Calm: It is very important that the adult present a balanced demeanor so that the student knows that he or she has permission to talk freely about the source of the distress.
  4. Be Honest With Yourself: Keep in touch with your own feelings and reactions to the student, the issues, and the situation. This is especially important in an emotionally-laden subject like homosexuality. If you feel you cannot handle the situation, ask someone else to take over, and arrange the transition.
  5. Validate Feelings: Listen well to the feelings that are being expressed by the student. Help the student clarify feelings. Use gentle probes for clarification and elaboration. Use increasingly focused questions when appropriate.
  6. Provide Information: The correct information at the right time can be very helpful. Be sure not to preach, however, and be sure that your own need to "do something" is not clouding your judgment regarding the timeliness of the information.
  7. Explore Resources: As soon as possible, explore with the student what resources he or she has available, and what their support system provides. Assist the student in deciding who, when, and how to reach out for that support.

Interrupting Homophobic Harassment

Q: On many occasions, teachers and peers will speak out against other forms of harassment and bigotry in the schools (e.g. racist, sexist, anti-religious discrimination), but are hesitant to interrupt homophobic or heterosexist epithets for fear of having their own sexuality called into question. What are your feelings about that?

LAH: I really believe that one of the things that is wrong with this country right now is that we have lost all touch with the fact that human beings are moral beings, and that this pretense that we should be completely neutral, including teachers, is to me absolutely ridiculous. This is true even in the therapy world: therapy and guidance people have espoused this so-called stance of neutrality. With the research that we have on violence, it is now very openly accepted that if health professions, for example, maintain neutrality in the face of another human being hurt, this is wrong. If you do not make a statement that helps define this act as an amoral act and as something that is socially unacceptable and against the law, then you are colluding. You have an obligation as a health or social service or educational professional to define things in the law that have been defined as criminal and as punishable.



  1. Wong, Doris Sue, and Hart, Jordana, "Answers Leave A Confounding Picture in Poll of Mass. High School Students," Boston Globe, May 20, 1994, p. 1.
  2. Fisher, P., Shaffer, D, "Facts about Suicide: A Review of National Mortality Statistics and Records," in Planning to Live: Suicidal Youth in Community Settings, ed. Rotheram-Borus, M.J., Bradley, J., Obolensky, N., Tulsa, Oklahoma, University of Oklahoma Press, 1990, pp. 1-33.
  3. Shaffer, d., Garland, A., Gould, M., Fisher, P., Trautman, P., "Preventing Teenage Suicide: A Critical Review," Journal of the American Academy of Child Psychiatry, 1988; 27 (6), pp. 675-687.
  4. Spoonhour, A., "The First Few Days are the Hardest," in People, Feb. 18, 1985, pp. 76-78.
  5. U. S. Department of Health and Human Services, "Gay Male and Lesbian Youth Suicide," by Paul Gibson, in Report of the Secretary's Task Force on Youth Suicide, ed. Marcia R. Feinleib, Washington, DC, January 1989.
  6. Quoted in Bull, Chris, "Suicidal Tendencies," The Advocate, April 5, 1994, p. 37.
  7. Gary Remafedi, quoted in Bull, Chris, "Suicidal Tendencies," The Advocate, April 5, 1994, p. 38.
  8. Remafedi, G., Farrow, J., and Deisher, R. (1991), "Risk Factors for Attempted Suicide in Gay and Bisexual Youth," Pediatrics, 87(6), pp. 869-76.
  9. Remafedi, G., "Male Homosexuality: The Adolescent's Perspective," Adolescent Health Program, University of Minnesota: Unpublished, 1985.
  10. Pollak, Michael, "Male Homosexuality" in Western Sexuality, eds. Phillippe Aries and Andre Bejin, NY: Blackwell, 1985.
  11. Joyce Hunter, quoted in Bull, Chris, "Suicidal Tendencies, The Advocate, April 5, 1994, p. 42.
  12. Bell, A., and Weinberg, M., Homosexualities: A Study of Diversity among Men and Women, New York: Simon and Schuster, 1978.
  13. Harry, J., "Adolescent Suicide and Sexual Identity Issues," submitted to the National Institute of Mental Health for the Secretary's Conference on Adolescent Suicide, Washington, DC, May 8-9, 1986.
  14. Huxdly, J., and Brandon, S., "Partnership in Transsexualism, Part 1: Paired and Non-paired Groups," Archives of Sexual Behavior, 10, pp. 133-141, 1981.
  15. Gerald Newberry, quoted in "Jack and Jack and Jill and Jill," by Richard Lacayo, Time, Dec. 14, 1992, pp. 52-53.
  16. Charlotte Patterson, quoted in "Debate Heated Over Teaching Children about Homosexuals," by Anthony Flint, Boston Globe, Dec. 13, 1992, p. 53.
  17. Benjamin Ladner, quoted in "Debate Heated Over Teaching Children about Homosexuals," by Anthony Flint, Boston Globe, Dec. 13, 1992, p. 53.
  18. Beth Winship, quoted in Blumenfeld, Warren J (ed.)., Homophobia: How We All Pay the Price, Boston: Beacon Press, 1992, back cover.
  19. Sharon Bergman, Testimony, Governor's Commission on Gay and Lesbian Youth, Boston.
  20. Bobby Griffith, quoted in Miller, B. Jaye, "From Silence to Suicide: Measuring a Mother's Loss," in Blumenfeld, Warren J. (ed.). Homophobia: How We All Pay the Price, Boston: Beacon Press, 1992, pp. 88-89.
  21. Mary Griffith, Testimony, Los Angeles School Committee, Public Hearings, June 23, 1988.
  22. JoAnne Cardell, Testimony, Governor's Commission on Gay and Lesbian Youth, Boston.
  23. Testimony, Governor's Commission on Gay and Lesbian Youth, Massachusetts State House, Boston, November 1992.

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