FORT LAUDERDALE, Fla. — On a spring morning near Orlando, a 17-year-old typed "I love you guys" on her Instagram page. Struggling with depression, distraught over a breakup, and fighting back tears, she walked out of class and into the empty high school auditorium. She pulled her grandfather's Glock 45 from her small brown purse and killed herself.
Roughly twice a week in Florida, a child or teenager takes their life. Nearly half of the time they use guns, most often belonging to a family member.
Such heartbreaking decisions by troubled young people have fueled a 50% increase in youth suicides in Florida during the last decade.
Yet guns are barely mentioned in youth suicide-prevention efforts by state and local authorities.
Florida's current suicide prevention plan, used to guide state and local agencies tasked with reducing suicides, doesn't include the word gun and uses the word firearm just once.
The risk of guns in the homes of mentally troubled young people wasn't mentioned at forums across South Florida this spring — even though the forums were called in response to the deaths of two Parkland teens who used household guns to take their lives within six days of each other.
It's time for that to change, many experts in suicide prevention say. As the rate of suicides among young people trends upward, a spotlight has been focused on the youth mental health crisis. But because of the staggering — and preventable — role that guns play in suicides, experts say the taboo subject of access to firearms must now become a key part of the discussion.
Dr. Scott Poland, a psychology professor and co-director of the Suicide and Violence Prevention Office at Nova Southeastern University in Fort Lauderdale, says it's time for parents and mental health professionals to be more direct with depressed teens about whether they have plans to use guns for self-harm.
"It's frustrating that the state doesn't make parent education around this risk one of its initiatives," Poland said. "This is not about confiscating guns. It is about helping parents understand the potential danger in their own homes."
With their unforgiving effectiveness, guns play an outsize role in all suicides. But they are especially dangerous in the hands of teenagers with undeveloped impulse control and a rising tide of mental health issues.
The 17-year-old who used a family gun to kill herself at Lake Mary High had struggled with mental illness for some time. Her boyfriend had broken up with her that weekend, police reports show. Three months earlier, she had cut herself so severely that she was taken to a psychiatric hospital.
Now armed with a gun, there was no saving her.
"The issue is guns are so lethal," said Thomas Joiner, a professor of psychology at Florida State University and national speaker on suicide prevention. "When these young people use a gun, nine out of 10 times it results in death."
A sensitive topic
Gun suicide among teens has touched every demographic in Florida: The 15-year-old soccer player from Miami-Dade on the cusp of taking her team to the playoffs. The 17-year-old artist from Weston who had already sold a few of her drawings. The 12-year-old Lakeland girl just starting middle school. The 15-year-old swimmer from Tampa who had earned All-American status.
Along with their despair, these teens had something else in common: Access to a gun in their family home.
Over the last decade in Florida, 1,054 people ages 10 to 19 killed themselves, and 44% used a gun, according to the Florida Department of Health. While those numbers are small relative to the population of Florida, the pronounced increase in the rate of youth suicides has alarmed experts in suicide prevention.
Over the past six months, the South Florida Sun Sentinel reviewed police and medical examiner reports of teen suicides in Florida, spoke with parents, community leaders, and suicide prevention experts, and attended town halls and public forums. While the rise of youth suicide is an acknowledged concern, discussion of the role guns play remains a taboo topic in suicide-prevention forums and is rarely mentioned in suicide-prevention workshops.
Suicide prevention efforts largely have avoided public discussion of the methods for fear of encouraging troubled people to hurt themselves and to avoid heightening the trauma of the survivors. But many experts in the field say that thinking also enabled prevention efforts to avoid the politically touchy subject of guns, and that now must change.
At a forum in West Palm Beach in August the moderator read aloud an audience question asking what schools are doing to help people understand the role guns play in youth suicide.
"That's a subject worth pursuing, but not today," said moderator Tom Robinson, a member of the national public policy council of the American Foundation of Suicide Prevention.
Robinson later told the Sun Sentinel he tries to avoid the political topic of guns, even though he recognizes it as a problem. "I don't want to get into an argument with someone where it becomes emotional," he said, adding that he personally sees a need to do more about gun safety. "That is a public health issue that needs to be addressed."
This year, Florida First Lady Casey DeSantis created "Hope for Healing Florida," a statewide initiative to bring awareness to mental health and substance abuse among the state's youth. When she launched the initiative, she cited statistics saying suicide is one of the leading causes of death in Florida's youth. Yet the program and her other recent efforts focused on youth suicide prevention do not specifically address education on access to firearms as a rising suicide risk.
At a meeting of the Florida Children and Youth Cabinet in November, a state board that DeSantis now chairs, suicide prevention expert Joiner shared his insights with her and the heads of key state agencies about the major role guns play in teen suicides in Florida. He recommended DeSantis' panel address it. His words of advice met with no response or follow-up discussion.
"I know this is sensitive political space, but their messaging should include gun safety," Joiner said in an interview with the Sun Sentinel. "This is not about the Second Amendment. It's about safety. You need to put distance between someone at risk and the means or methods they are focused on."
Barbara Markley of the Broward League of Women Voters said she has tried to get state and school officials to educate families on the risk guns play in youth suicide, with little success.
"Everything is political and you're not allowed to say the word gun," Markley said. "I would like to see a statewide push. It isn't there now."
Markley chairs the Gun Safety Committee of United Way of Broward's Suicide Prevention Coalition, which has distributed more than 26,000 safe gun storage brochures and 13,000 gun locks in South Florida.
In the last year, Markley has asked state leaders to include safe gun storage in its future suicide prevention plan. They have agreed to let her make a presentation to them. She also has asked the Broward school district to send a safety message to all families about how important it is to lock up guns. So far, her requests have been denied, she said.
Poland, the NSU professor who is a nationally recognized expert on suicide prevention, said he has offered to talk to parents at local schools about safe gun storage. "Many principals are uncomfortable with the topic," Poland said. "But we need to educate parents on the warning signs of suicide and tell them 'If you see the signs in your family member, secure your guns.'"
Broward Schools Superintendent Robert Runcie told the Sun Sentinel he doesn't see gun safety in relation to suicide as a topic the schools should address. "We haven't done anything in terms of necessarily educating parents on how they ought to safeguard their firearms, he said. "We can't be all things on every topic to everyone."
Pediatricians in Florida can use wellness visits to raise parents' awareness of potential risks from unlocked guns at home, especially for teens with depression or substance abuse. But that hasn't always been the case in Florida — nor does it mean pediatricians are actually having those conversations.
In 2011, Florida passed an unusual law forbidding pediatricians from asking families whether they own a gun or have one in the home.
The National Rifle Association lobbied for the law, arguing that allowing pediatricians to ask about gun ownership interfered with patients' Second Amendment right to bear arms. Doctors challenged it in court, and ultimately prevailed in 2017, when the U.S. Court of Appeals ruled the law infringed on doctors' freedom of speech.
But even though doctors in Florida are free to ask about access to household firearms, many still hesitate, said Judith Aronson Ramos, a South Florida pediatrician and co-chair of Florida chapter of the American Academy of Pediatrics gun safety task force.
"Suicide is a serious concern," she said at suicide-prevention forum in September. "When there is access to firearms in a home, the risk of suicide is much greater, which is why safe gun storage is something of primary importance."
Volatile teens without impulse control
Teens are far more likely than adults to impulsively take their lives in response to a crisis, studies show. That in-the-moment thinking is what can make easy access to guns such a risk for troubled youths.
Minutes after a Palm Beach County mother took away a 16-year-old's cellphone as punishment for missing school in May 2017, the boy went to an upstairs bathroom and shot himself with his father's semi-automatic pistol, a police report shows.
Link between teen suicides and personal crises
One-third of young people who died by suicide had faced a crisis in the previous 24 hours, according to police and medical examiner reports. That crisis could be anything from a relationship break-up to an argument with a family member, or even the perception of failure in a school class.
Source: Harvard Injury Control Research Center
In an extensive multi-state study of U.S. teens who had taken their lives, about one-third had experienced a crisis within the previous 24 hours, according to 2001 data from the National Violent Injury Statistics System, which is drawn from police and coroner reports. In some cases, the crises were not just same-day, but same-moment.
Catherine Barber, director of the Means Matter Campaign at the Harvard School of Public Health's Injury Control Research Center, has read through hundreds of records on youth suicides. "So often I think, 'Wow, this could have been prevented,'" if only the child had not had a gun, she said.
Barber found teens often act impulsively after a fight with a parent, an argument with a boyfriend or girlfriend, or in response to public humiliation. They reach for a gun — when it is available.
"This doesn't mean they took their lives out of the blue, because they usually were troubled for a period of time," Barber said. "But in the moment, they just couldn't take it and wanted to figure out a way to die."
MISSING THE CUES
Katie Green and her husband kept shotguns in their West Palm Beach home for years and took family trips to go skeet shooting. She did not consider those guns a risk because the children had grown up around guns.
What she didn't know: how troubled her 18-year-old daughter had become.
The young woman was home from military school for Thanksgiving break four years ago when she received a call from her captain informing her she was failing academically. The next day, she went on a walk and killed herself with the family's semi-automatic shotgun.
"Kids are just very impulsive. They don't have the perspective of time and life to understand things can change," Green said.
Green still struggles to make sense of the tragedy. She says she attributed to teenage moodiness what now appears to be something deeper. At the time, she did not know her daughter was depressed or suicidal, she said.
"As a parent, I look back and think, how could I have been so clueless? I'm an intelligent person," she said. "I don't know how this happened. I was just doing the best I could."
Green isn't alone. Jody Sanders also never dreamed her 15-year-old son would use one of the family's guns to harm himself.
Many parents who readily worry about small children playing with guns don't have the same concern about teenagers. What they can overlook: The inner turmoil that teens may be suffering — and the likelihood that a teen knows where the key to the gun lock is hidden and where the bullets are stored.
Sanders' son Vance, 15, was a skeet shooter and comfortable around the family's guns.
The high school swimmer from Clearwater had hit a rough patch. His grades had slipped and his girlfriend had broken up with him. He had quit the swim team and tried unsuccessfully a few days later to rejoin the team. His mother said she did not realize how deeply hopeless her son had become.
"In hindsight, I wish I had picked up on some of the cues," his mother said. "Teenagers are very volatile people."
Sanders said she trusted her son's respect for safe weapon practices and would have blocked access to the gun if she recognized the signs of his despair.
"Even though we had all our guns locked up, we keep the ammunition and guns separate," she said. "We don't know how he got hold of a bullet, but he must have put some thought into it."
Her message to other parents: Lock up your guns around teenagers and talk to them about suicide.
"As parents, it's easy to let our guards down, but when you have guns in the house you need to take extra precautions," said Sanders, who now runs a suicide-prevention foundation and annual fundraiser in her son's memory. "When someone wants to kill themselves, a gun is a simple means. The harder you make it, the higher the chance of them continuing to live."
Jennifer Mitchell offers parents the same message. Her son, Ian Ezquerra, 16, an honors student and swimmer at East Lake High School in Pinellas County, shot himself with his father's gun in August.
"He had a false sense of security that our son was responsible enough around guns to leave unattended," Mitchell said. "Young people are not responsible enough to handle firearms, and they should never have access to one without adult supervision — period."
Mitchell said her experience has made her realize that with the deadly nature of guns, there is no chance for teens to think "I want to live" after a trigger is impulsively pulled.
"When people said my son would have found another way, it pisses me off. I do not believe that in my heart," she said. "He didn't have the option to change his mind because it was instant."
ARMED IN AMERICA
There is no countrywide database where people register their guns. But a 2017 study by Pew Research Center put the U.S. gun ownership rate at three in 10 adults. Florida mirrors that trend, studies show.
While permits are only a partial indicator of ownership, the number of concealed weapon permits in Florida has more than tripled in the last decade. Today more than 2 million people — one of every eight adults in Florida — is licensed to carry a concealed weapon, according to the Florida Department of Agriculture and Consumer Services.
A Boston professor who has studied the correlation between gun ownership and child/teen suicide found the strongest single predictor of a state's youth suicide rate is the prevalence of household gun ownership in that state.
"We don't know what percentage of guns are locked or loaded, but if there is any lesson, it is that having a gun in the household is a risk factor for teen suicide," said Dr. Michael Siegel, a professor at the Boston University School of Public Health.
Two Florida legislators want to strengthen and expand the scope of Florida's law regulating safe storage of guns during the upcoming 2020 session.
The current law requires gun owners with a minor in the home to use a trigger lock, or keep their firearm in a securely locked container in a location that a reasonable person would believe to be secure. It's a misdemeanor if the minor has the gun in a public place or uses it in a careless or threatening way.
State Sen. Gary Farmer is proposing legislation to also make it a misdemeanor if a gun is not properly secured, whether a minor gets hold of the gun or not. His proposal requires gun owners to use a locked container or a trigger lock at all times, even when carrying the weapon.
Rep. Tina Polsky, D-Boca Raton, also has proposed legislation for the 2020 session. Her version changes the definition of minor to anyone under 18 rather than 16, as the law now reads. In addition, she wants sellers of firearms to provide buyers with a safety brochure at the time of purchase that explains the storage law.
"Something has to be done," she said. "Guns are too accessible to minors."
SHOULD THE CONVERSATION CHANGE?
Dr. Sofia Castro, director of the Office of Suicide Prevention, is the only person who works for the state of Florida whose job is devoted solely to suicide prevention. She told the South Florida Sun Sentinel her goals are not targeted to any specific age group, nor do they include conversations about educating parents on the risk of firearms in their homes.
Castro's boss, Rodney Moore, Assistant Secretary for Substance Abuse and Mental Health for Florida's Department of Children and Families, said rather than focusing on guns when educating parents or caretakers, "it's important to focus on all activities that put a person at risk. If someone is determined to take their own life, you have to look at everything they will go through. Getting hung up on any one thing is the wrong approach."
First Lady DeSantis leads the state's Children and Youth Cabinet, which recently took up the cause of youth suicide prevention, but the attention is on creating mentorship programs and at this point has not addressed young people's access to guns. DeSantis did not respond to multiple attempts to reach her about the initiative.
Siegal, the professor of Public Health at Boston University who studied gun ownership related to youth suicide, said helping teens address their mental health is just part of the solution.
"There is a more structural cause of youth suicide, which is gun availability and gun access," he said. "I am not saying not to address mental health, but if you do that without addressing access to guns, it is not going to accomplish as much."
Staff writer John Maines contributed to this report.