Word got out fast, and by lunchtime Wednesday, April 9, most of the students at South Medford High School knew a classmate was dead.
"There was no announcement, but they all knew," said Kristen Schuch, a mental health interventionist at the school.
As of Wednesday, there had been 17 confirmed suicides this year among all age groups — 14 by gunshot and three by hanging — as well as other "accidental deaths," many involving drug overdose, that may have been suicides but were not ruled as such because there wasn't enough evidence, she said.
There were 33 confirmed suicides in 2010, 46 in 2011, 42 in 2012 and 51 in 2013, Carlson said.
By the end of April, Medford Police Department had handled 171 suicide and attempted suicide cases — a nearly 26 percent increase over the 136 cases that occurred by the end of April last year.
An 18-year-old South senior had hanged himself from a tree in the back yard of a home on East 11th Street in Medford shortly before 10 a.m. April 9.
For Schuch, who has been a counselor for 12 years, it was the first time she had dealt with a young person's suicide. In the aftermath, she and several guidance counselors at South met with his close friends individually and organized a crisis room at South for students to come in and talk about their grief.
Talking with a school-based mental health counselor was not an option a year ago in Medford schools. But the increasing number of issues cropping up among students prompted the Medford School Board to approve placing mental health interventionists in each of its secondary schools.
The need was evident at South Medford in the aftermath of the suicide. In the two days following the death, 30 to 50 students stopped by the room to talk with Schuch or one of the academic counselors at the school.
"There was a lot of crying, and there was a lot of people on their phones communicating through social media, and kids talking about him and the kind of person he was," Schuch said. "I had support from the school, but it was hard. It was really hard."
Schuch talked with students about the stages of grief and how grief is a personal experience that everyone handles differently.
"I let them know I was here and available to them at any time and told them that if they were concerned about any other friends to come to me," she said.
While it was the first school death she has dealt with, it was far from the first time Schuch has worked with teens in crisis. Over the past six months, Schuch says she has seen more than 120 students experiencing suicidal thoughts, anxiety, abuse and family issues, including 59 students she described as "in crisis." More than half returned for follow-up sessions. Many of the students were referred to her by staff members, and others by concerned friends.
"I just try to provide somewhere they can come and vent in a confidential way," she said. "I meet them where they are at and respect what they say and what their perspective is."
Last spring, the Medford School Board budgeted about $200,000 to hire mental health interventionists. In December, the district contracted with Family Solutions to hire five mental health interventionists — four full-time and one part-time — who were assigned to North, South and Central Medford high schools, and Hedrick and McLoughlin middle schools.
This year, district administrators recommended that the board allocate an additional $22,000 to have a full-time interventionist at Central and that it hire more interventionists if funds become available.
"The number of cases we are seeing that are being reported as suicidal ideation or self-harm has increased, and the advantage of having someone right there to handle the crisis is crucial," said Todd Bloomquist, the Medford district's director of secondary education.
Suicide is the second-leading cause of death in Oregon for youths ages 10 to 24, according to Oregon Health Authority.
Anna D'amato, with Jackson County Mental Health, said she has noticed a dramatic increase in the number of calls placed by people younger than 18 to the county's mental health crisis hotline, which is available 24/7.
"We were getting one or two calls a month from youth, and now we're getting two to three calls a week," she said.
Schuch said about 90 percent of the students she sees have had passive thoughts of death, such as "I wish I weren't here," "I wish I wasn't born," or "No one would miss me if I was gone," while a much smaller percentage actually have a plan in place.
Aura Reicherr, North's mental health interventionist, said about 40 percent of her caseload is either students having suicidal thoughts or students who are concerned about a friend who is having suicidal thoughts.
"First, I do an assessment, 'Does this student meet the criteria for immediate risk?' " she said. "If so, I call the parents or JCMH and get them transported to the hospital, if needed. Otherwise, I talk to them, and in some cases, JCMH comes on site to do an assessment."
Reicherr said she has gone to the emergency room with several students.
At Asante Rogue Regional Medical Center, the youth is checked by a psychiatric nurse and emergency doctor who almost always consult with crisis workers from Jackson County Mental Health to determine what action to take, said hospital spokesman Grant Walker.
If the person is in danger of self-harm and is 18 or older, he or she is placed on hospital hold in the behavioral health unit, where they can remain for up to five business days.
However, the only two pediatric psychiatric units in Oregon are located in Portland, and "every county in the whole state is competing for those beds," said Kathryn Steinmetz, a local psychiatric nurse practitioner and chairwoman of the Suicide Prevention Coalition of Jackson County.
People who are younger than 18 and are in danger of suicide or self-harm are admitted to RRMC's two-room psychiatric care unit in the emergency department or, if the child is not displaying violent behavior, either the intensive care unit or pediatric unit.
"It's pretty scary having a kid in the middle of a psychiatric crisis in a little pediatric unit, which isn't set up for that," Steinmetz said.
Between 2008 and 2012, there was a 149 percent increase in the number of people younger than 18 getting mental health support at the hospital and a 63 percent increase in the number who needed to be held overnight, said Steinmetz.
"And it's gotten exponentially worse since then," she added.
More than 80 kids with mental health issues — not necessarily suicidal — visited RRMC between November 2013 and Jaunary 2014, said Amy Buehler, children's services manager for JCMH.
Reicherr said breakdowns typically follow Christmas break, spring break, summer break or any extended period of time at home.
"Students tell me all the time that school is the only place they have support," she said.
Reicherr has met with 128 North students since December, including 55 described as "in crisis." They are dealing with a wide variety of worries: sexuality and gender issues, teen parenting, family crises and parents who are addicted to drugs or alcohol.
"My job is extremely important because I teach students who wouldn't otherwise know how to manage to deal with their stress and to find other solutions besides suicide, self-harm, or drugs and alcohol," she said.
"I say 80 percent of what I do is reparenting," she added.
McLoughlin Middle School Principal Linda White said mental health interventionists have been "a huge, glaring need at the middle schools."
"I don't really know what we did before we had these guys," she said at a work session with the Medford School Board earlier this month.
McLoughlin's interventionist, Nick Heim, said students often use self-harm as a coping mechanism for stress that they don't know how to deal with. Other students turn to food, alcohol, drugs or even over-exercising for the same reason, he said.
"So what I do is try to help them lower their stress while suggesting a more positive coping mechanism," he said. "And long term, I try to increase their ability to cope with stress and the related feelings and emotions."
Heim has ongoing appointments with 48 students. Sometimes he meets with peer groups to discuss self-esteem, body image and stereotypes. Last week, he and a student made about 10 laps around the McLoughlin track while they worked through the student's crisis.
Oregon law requires that Heim involve parents if he is going to meet with students 13 and younger more than twice. But before making that call, he tries to have a support plan in place to share with the parents.
"Luckily, the parents have been awesome and care about their kids and are grateful that we have this at the schools," he said.
Before the school year ended Friday, the interventionists flagged students who were at greater risk and asked them to sign a release form so county Mental Health Department staff can check in with them this summer, said Buehler.
Someone is more at risk of suicide if they have previously attempted suicide, are emotionally or physically isolated, know someone who has committed suicide, have a history of substance abuse, or have access to firearms or "other lethal means," said Buehler.
"As a community, we are responding to the crisis, but we need to get better at identifying someone at risk who needs support," she said. "If you're in a car accident, it makes sense to go in and get checked out. If you have allergies, it makes sense to go in and get your medication adjusted annually. And so it should be OK to get mental health assessments. It doesn't have to be ongoing treatment, maybe it just needs to be having someone unbiased who is willing to listen."