Four teens took their own lives in Juneau since early fall, and eight young adults have committed suicide in the past year and a half.
"When you start counting, it gets scary," said Doug Wessen, a school district psychologist.
The tragedy is striking Juneau families and few people want to talk about it.
"If we had eight auto accidents with these deaths, we'd be up in arms," Wessen said. "But because there is a stigma with this, we tend not to talk about it."
Mental illness causes a majority of suicides, and awareness of the signs and symptoms of depression can help prevent suicide. But drug and alcohol use is frequently associated with depression, and professionals say the level of substance abuse in Juneau is high, even among teenagers.
Juneau, like other communities, lacks the social services needed to provide adequate treatment for these problems. But people who work with teens agree it's time to start finding some solutions.
Talking about it is a start, they said.
Juneau police took notice of the number of suicide deaths when officers said they seemed to be going to a lot of calls, said Lt. Kris Sell with the Juneau Police Department.
"We are seeing an increase in activity," Sell said.
The number of deaths was determined during a series of meetings last fall, including psychologists, pastors, police, counselors and others who informally listed recent suicide deaths in Juneau.
Records don't provide a complete picture of the number of deaths by suicide because police aren't always involved, or an overdose or accident might not be confirmed as a suicide. Police data, however, indicates suicide deaths have increased in Juneau in the past year.
Ninety-five suicide attempts of all ages were confirmed in 2007, compared to 76 in 2006, according to the police department. Seven suicides were confirmed in 2007, compared to four the year before.
Of those seven last year, three were teenagers, police reported.
The numbers indicate Juneau had a suicide rate among teens of 9.9 deaths per 100,000 last year. The national suicide rate among people age 10 to 24 is seven to nine deaths, according to a report by the Centers for Disease Control and Prevention that studied incidences through 2004.
No connection existed between those who killed themselves in Juneau, and factors leading to their deaths were different in each case. The victims did not share economic status, race or even common friends, Sell said.
"The cases are crossing the board," she said, but noted that substance abuse is an aggravator for just about every social problem. "We're talking about a spider web of issues."
Because Juneau is a small community, the deaths are pervasive to the point that most teenagers know someone who killed themselves. But those interviewed by the Empire said that few people really talk about it.
"Nothing is said about it, not really," said Lawrence Fenumiai, a Juneau-Douglas High School senior who said he knew three young people who killed themselves in the past year.
A recent survey showed that 17.8 percent of students in the Juneau School District "seriously" considered killing themselves during the previous year. Sixteen percent of girls and 12 percent of boys at Juneau-Douglas High School said they had made a plan about how they would attempt suicide.
The statistics run closely with teen responses across the nation, but because Alaska requires that parents sign a permission slip for kids to participate, survey administrators say the figures could be skewed. About 60 percent of Alaska students participated in the survey in 2007.
Adults might be surprised by the results, said Mary Tonsmeire, health care coordinator for the Juneau Teen Health Center.
"As adults you feel like they're young - what do they have to be so depressed about? I don't think the feelings are generally understood or taken seriously," Tonsmeire said. "I think people might have a tendency to not believe such a high percentage responded that way."
But Laury Scandling, principal at the alternative school Yaakoosge Daakahidi, said she was not surprised.
Teens are bombarded with images and a standard set by media to be "sexy, popular, booked up and own a whole lot of stuff to be cool," Scandling said. They are exposed to drugs and alcohol and are navigating intimate relationships for the first time, figuring out where they fit in in the world and moving from being a kid to being a man or a woman.
The medical community speculates that brain development is not complete until the mid-20s, and that the last neurological developments affect the ability to fully understand consequences or control impulses. Teens don't yet have all the tools in their tool box to deal with life's stresses, so to speak, and they lack experiences to show them things can get better.
"You have a potent brew that can lead to an irrational decision. It's a very pressured time of life," Scandling said.
But taboos surrounding mental illness unfortunately prevent people from talking about it, she said.
"We need to let kids know there is no shame in letting someone know you need some help. That's a sign of strength," Scandling said.
One risk of talking about suicide and its underlying problems is that it can create a panic, said Dr. Paul Topol, director of Bartlett Regional Hospital's mental health unit and the Rainforest Recovery Treatment Center for substance abuse.
There is no perfect way to determine if a child is sad, depressed or suicidal, he said. Adolescents are moody by definition, potentially frustrating adults who don't know how to respond.
And there are challenges beyond the stigma. While people can begin to discuss potential solutions, the answers are difficult, Topol said.
Depression is widely blamed for a majority of suicide deaths, but a Centers for Disease Control and Prevention study indicates that only about one-third of teen suicide victims appear to satisfy clinical criteria for depression or other treatable mental illness.
Topol estimated that about half the suicides in Alaska involve alcohol or drugs.
Treating only for depression will probably not eliminate or even substantially reduce the suicide problem, he said.
"If we could combine depression and substance abuse, then we could have an impact."
Topol agreed the community needs to start a dialogue, but he said it's going to be painful. Juneau's ambivalence toward alcohol - a general acceptance of drinking as a way of life in Alaska - is a big part of the problem, he said.
Still, he offers a hopeful notion: "This is a small community and Alaska is a rich state. We have the opportunity to address these issues if we choose to do so."
Contact reporter Kim Marquis at 523-2279 or firstname.lastname@example.org.