When she was a sixth-grader suffering from bulimia, Emma Martinez felt confused, broken and alone at school.
More than two years later, Martinez, 15, has recovered, but the eighth-grader often thinks about what could have happened to her without the support of her mother, a social worker.
That's why she's a member of Hope Squad, a peer-led suicide-prevention program started at Hilliard Heritage Middle School. She's determined to keep students from feeling the way she once did.
"It completely wrecks you," Martinez said. "If I can be there for someone and help point them in the right direction, that would just mean so much. As a survivor of a ... mental illness, a person who's gone through that, I feel an obligation to do it."
Facing an increasing number of youth suicides, more central Ohio schools are educating not just staff members, but also students about how to spot warning signs in struggling peers. Dublin, Hilliard and other districts incorporate lessons into health classes. Others are implementing standalone programs.
Often, students eagerly take the lead in reducing the stigma surrounding the conversation.
Nationwide, suicide rates have been increasing steadily since 2007, and suicide now is the second-leading cause of death among youth and young adults, behind accidental injuries such as a car crash, according to the federal Centers for Disease Control and Prevention.
From 2008 to 2017, 1,373 Ohio adolescents (ages 10 to 21) died by suicide, including 117 in Franklin County, according to newly released data from the Ohio Alliance for Innovation in Population Health, a collaboration of researchers from Ohio University and the University of Toledo.
Some seeking answers might be quick to point to social media or bullying as a cause, but the issue is more complex, said Austin Lucas, Ohio Suicide Prevention Foundation grant coordinator.
Hilliard City Schools' program helps students guide peers to professional help. Students in grades 6 to 12 elect representatives from their class to participate.
Two students at Hilliard Davidson High School died by suicide last year, which partially prompted officials to obtain federal grants this year to start using the program from the Cincinnati-based nonprofit Grant Us Hope.
Students involved said several peers already have reached out for help. The students also coordinate events to promote positivity in the school.
"It's about being there for people when they're down, and spreading kindness," said Phil Cox, 12, a seventh-grader at Hilliard Weaver Middle School. "We're an outlet for people, so they know where to go when they need help, because it can be scary to take that step."
In Westerville, students spread that same message after a 17-year-old junior attempted to hang himself during the school day in front of his classmates at Westerville Central High School in November. The student survived.
The next day, students spontaneously covered the school's walls and staircase with thousands of vibrant sticky notes featuring messages of hope.
Art teacher Derrick Ehlen keeps a box of the colorful, inspiring notes in his classroom, and students are using them in permanent art installations throughout the guidance area.
John Ackerman, a suicide-prevention coordinator at Nationwide Children's Hospital, said the public conversations at schools mark a significant change from years ago, when officials would tell him mental-health problems and suicide weren't issues at their schools.
Meanwhile, Ackerman said, he was treating many of their students.
Since 2015, the hospital has partnered with schools in central and southeastern Ohio to start Signs of Suicide programs, which train staff members and students and direct them to help. The free partnership already has reached about 30,000 kids and is expanding, Ackerman said.
"We're shifting the dialogue from 'Are behavioral health issues real?' to 'What can we do about it?'" Ackerman said. "I'm a much bigger fan of that conversation."
At the state level, lawmakers are discussing what can be done.
In March, an Ohio law took effect that requires public-school teachers, nurses, counselors, psychologists and administrators to complete four hours of training in suicide awareness and prevention within their first two years of employment, then every five years thereafter.
Such training has been required by law since 2013, but without specifics about frequency.
Ohio legislators now are considering a bill that would change that requirement to one hour of training every year and also mandate schools provide instruction about the topic for students in grades 6 to 12.
House Bill 123, introduced in March by state Rep. Glenn Holmes (D-Girard) and state Rep. Gayle Manning (R-North Ridgeville) also mandates the Ohio Department of Education adopt a model curriculum and post a list of peer-reviewed, evidence-based suicide-prevention training programs for staff members on its website.
Still, some question whether such requirements are enough.
Representatives of the Ohio School Psychologists Association and Ohio School Counselor Association say hiring more of their professionals in schools would make a difference, but that's a challenge for districts struggling to balance budgets.
Recommended ratios are about 500 to 700 students for one psychologist and 250 students for one counselor. But nationally, caseloads are three to five times that amount in many schools, and sometimes there is no support at all, officials from the associations said.
Elementary schools often face the most challenges.
Ericka Hecker, a counselor for Bexley's Cassingham Elementary School, said building foundations for student wellness, especially at a young age, is a crucial part of suicide prevention.
Next year, the district will bring its eight part-time counselors to full-time roles to continue that undertaking, Bexley Schools spokeswoman Gianna Harrison said.
As they get older, students said receiving both professional and peer support is key.
For example, four Grandview Heights High School students teamed up with counselor Bryan Stork to organize an assembly in March featuring the band Pray for Sleep, a group of adolescents that uses metal music to raise awareness about mental-health struggles.
Even if the music weren't for everyone, attendees all respected the message, organizers said. A follow-up survey of 78 students found a majority were more likely to seek help following the experience.
"Even if it helped just one person, that's good," said senior Shea McHugh, 17. "We need to get rid of the stigma and let people know it's OK to not be OK."
If you or someone you know is considering suicide, call the Franklin County Suicide Prevention Hotline at 614-221-5445; the Teen Suicide Prevention Hotline at 614-294-3300 or the National Suicide Prevention Lifeline at 1-800-273-8255; or text the Crisis Text Line at 741-741; or connect to the Lifeline Crisis Chat at crisischat.org.
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