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K.Hacker et al.: Coping withYouth Suicide and OverdoseCrisis2008; Vol.29(2):86–95© 2008Hogrefe& Huber Publishers
Research Trends
Coping with Youth
Suicide and Overdose
One Community’s Efforts to Investigate,
Intervene, and Prevent Suicide Contagion
Karen Hacker1, Jessica Collins2, Leni Gross-Young3,
Stephanie Almeida4, and Noreen Burke5
1Institute for Community Health, Cambridge, MA, USA, 2Somerville Community Health Agenda,
Cambridge Health Alliance, Cambridge, MA, USA, 3Trauma Response Network, Somerville Health
Department, Somerville, MA, USA, 4Somerville Cares About Prevention, Somerville Health Department,
Somerville, MA, USA, 5Somerville Health Department, Somerville, MA, USA
Abstract. From 2000–2005, Somerville, MA, experienced a number of youth overdoses and suicides. The community response followed
CDC recommendations for contagion containment. A community coalition, Somerville Cares About Prevention, became a pivotal con-
vener of community partners and a local research organization, the Institute for Community Health, provided needed expertise in sur-
veillance and analysis. Mayoral leadership provided the impetus for action while community activists connected those at risk with mental
health resources. Using a variety of data sources (including death certificates, youth risk surveys, 911 call data, and hospital discharges)
overdose and suicide activity were monitored. Rates of suicide and overdose for 10–24-year-olds were higher than in previous years.
Using case investigation methods, the majority of suicide victims were found to be linked through common peer groups and substance
abuse. Subsequent community action steps included: a community-based trauma response team, improved media relationships, focus
groups for suicide survivors, and prevention trainings to community stakeholders. Youth suicide and overdose activity subsided in May
of 2005. The community partnerships were critical elements for developing a response to this public health crisis. This collaborative
approach to suicide contagion used existing resources and provides important lessons learned for other communities facing similar
circumstances.
Keywords: youth suicide, suicide contagion, overdoses, community coalition
Introduction
Suicide is a leading cause of death among young people in
the US (Gould, Wallenstein, Kleinman, O’Carroll, & Mer-
cy, 1990) and although the rate of adolescent suicide has
declined over the last decade (Gould, Greenberg, Velting,
& Shaffer, 2003), the impact of even one youth suicide on
a community can be far reaching. Episodes of suicide con-
tagion among young people have occurred nationally and
internationally (Gould, Wallenstein, & Davidson, 1989;
Gould, 2004). Suicide contagion, as defined by the Centers
for Disease Control and Prevention (CDC), is “a process
by which exposure to the suicide or suicidal behavior of
one or more persons influences others to commit or attempt
suicide” (CDC, 1994). Adolescents are disproportionately
affected by this contagion. Some studies have estimated
that clusters may account for 1% to 5% of adolescent sui-
cides (Gould et al., 1990; O’Carroll & Mercy, 1990; Mercy
et al., 2001). Explanations for suicide contagion may in-
clude heightened community awareness, media attention,
imitation among peer group members, and glorification of
the deceased (O’Carroll, Crosby, Mercy, Lee, & Simon,
2001; CDC, 1988; Pirkis, Blood, Beautrais, Burgess, &
Skehan, 2006).
The public health approach to contagious entities in-
cludes investigation, case-finding, and intervention and
prevention strategies. The National Strategy for Suicide
Prevention advocates such an approach for suicide preven-
tion (U.S. Department of Health and Human Services,
2001). Specific recommendations for contagion contain-
ment were published by the CDC in 1988 (CDC, 1988). It
is clear that orchestrating a coordinated community-wide
response is critical for success. Community coalitions can
be important vehicles for mobilizing community members
DOI 10.1027/0227-5910.29.2.86
Crisis 2008; Vol. 29(2):86–95 © 2008 Hogrefe & Huber Publishers
and exponentially expanding the reach of any efforts. In
addition, access to suicide data will assist the community
in making informed decisions about intervention and pre-
vention strategies (Suicide Prevention Resource Center,
2007).
In Somerville, MA, a series of youth suicides and over-
doses occurred from 2000–2005. In keeping with the CDC
recommendations, a community coalition, Somerville
Cares About Prevention (SCAP) in partnership with the
Institute for Community Health (ICH), a local community-
based participatory research organization, led the citywide
response. This paper will describe the process that the Som-
erville community employed to investigate, intervene, and
prevent suicide contagion.
Background
Somerville, MA, is a city of 77,478, which borders Boston
and the cities of Cambridge, Arlington, Medford, and Ev-
erett (U.S. Census Bureau, 2000). It is a city that has
changed substantially both economically and demographi-
cally in the last decades. While the number of white resi-
dents has decreased, all other ethnicities have increased. In
2005, 32% of Somerville residents were estimated to be
foreign-born from diverse countries such as Brazil, Portu-
gal, El Salvador, Haiti, and China compared to 29% in 2000
(Community Action Agency of Somerville, 2005; About
Somerville, 2007). Simultaneously, the average home price
escalated from $231,595 in 2000 to $428,450 in 2005, an
increase of 87% (Somerville Mayor’s Office of Strategic
Planning, 2005). Long-standing working-class residents
can no longer afford their own parents’ houses. Gentrifica-
tion and immigration have led to tensions between native
Somervillians, transplanted residents, and ethnically di-
verse immigrant groups. Disaffected youth have expressed
their dissatisfaction through graffiti in local parks (Parker,
2005).
Somerville is also a community that has been plagued
by long-standing substance abuse. Heroin and other opiate
use has been growing in the region (Massachusetts Depart-
ment of Public Health, 2006). The arrival of oxycodone and
other oral pain killers in the late 1990s created a particular-
ly risky environment for substance abusers and a threat for
young persons involved in experimentation (Paulozzi,
2006). This triad of economic change, long-term substance
abuse, and diversification is the back-drop against which a
suicide increase in youth overdoses and suicides occurred.
The First Overdose and Suicide
Recognizing the first death in a suicide contagion can be
difficult. Unfortunately, it is often only in retrospect that
the first influential death is acknowledged as a trigger for
others. While several youth suicides had taken place in pre-
vious years, it wasn’t until 2001, when one young man took
his own life and two popular high school students died of
oxycodone overdoses, that concerns about contagion began
to surface. One of the young men who died was particularly
well known and a popular member of the Somerville High
School hockey team.
In 2002, the Somerville Health and School Departments
conducted their first high-school teen health survey based
on the CDC Youth Risk Behavior Survey (YRBS; Brener,
Collins, Kann, Warren, & Williams, 1995). The survey as-
sessed risky behaviors in a number of areas and included
the YRBS questions on suicide behaviors (depression, self-
reports of suicidal thoughts, plans, and attempts in the last
12 months). The results found that 38% of the 1,337 stu-
dents who responded said they had felt so sad or hopeless
almost every day for 2 weeks or more that they stopped
doing some usual activities during the past 12 months (43%
of females and 34% of males), 21% said they seriously
considered suicide (22% of females and 19% of males), and
14% of students said they had attempted suicide during the
last 12 months (14% of females and 14% of males) (Som-
erville Health Department, 2002). The rate of attempts was
almost twice the national rate.
Based on these results, the Institute for Community
Health (ICH) was engaged to conduct an assessment of
mental-health and substance-abuse needs in the high school
(Gall et al., 2002). The final report noted that there was an
existing atmosphere of “tolerance” of drug and alcohol use
in Somerville and that the surge in drug-related youth
deaths and suicidal behaviors represented an increase from
previous behavior. The level of existing services did not
meet the demonstrated need.
Community Coalition Building: Critical
Partners
Members of an existing coalition, SCAP, began to emerge
as leaders in orchestrating a community response to the
suicides and overdoses. SCAP, originally formed to address
historic substance abuse problems, had already brought to-
gether a diverse group of stakeholders including commu-
nity leaders, agencies, and activists and was poised to mo-
bilize the community.
Then in 2002, with the election of a new mayor, the co-
alition received the necessary support to convince critical
stakeholders that a public health crisis was occurring. The
Mayor, a life-long resident of Somerville, had known sev-
eral of the victim’s families and acknowledged the problem
of drug abuse in his inaugural speech of 2003 (Curtatone,
2003). Subsequently, two task forces were convened: The
Mayor’s Suicide and Mental Health Taskforce and the
Mayor’s Opiate Taskforce. They engaged citywide depart-
mental leadership (schools, police, fire) and community
mental health partners and were charged with investigating
the growing crisis and strategically planning solutions.
K. Hacker et al.: Coping with Youth Suicide and Overdose 87
© 2008 Hogrefe & Huber Publishers Crisis 2008; Vol. 29(2):86–95
Developing a Surveillance System
Taskforce members needed information in order to answer
several critical questions: (1) Were the suicide and over-
dose deaths significantly elevated from baseline? (2) Were
there common links between victims and was this a conta-
gion/cluster? While Somerville had no existing surveil-
lance system, several data sources were available for this
purpose.
Death Certificates
Death certificates are maintained by the City Clerk in Som-
erville, MA. They include information on age of the de-
ceased, gender, and cause of death. They are initially filed
with the city before being sent to the state Registry of Vital
Records and Statistics. Coalition members began examin-
ing death certificates in 2001 and continued to do so
through December 2007 to identify all deaths in a rapid
manner. Subsequently, death certificates were examined
back to 1994 for comparison.
State Data from MassCHIP
Mortality data, available electronically from the state
through MassCHIP (Massachusetts Department of Public
Health, Massachusetts Community Health Information
Profile, 2007), were extracted on fatal drug overdoses and
suicides for 10–24-year-old Somerville residents for 1994
through 2005 (the most recent available through Mass-
CHIP). Data on self-inflicted injuries and opiate-related
hospital discharges (1994–2006) for Somerville residents
were also reviewed.
According to death certificate data, there were 21 sui-
cide- and overdose-related deaths of people between 10–24
years of age (11 suicides and 10 overdoses) that occurred
in Somerville between January 2000 and December 2005.
Three of these young persons did not live in Somerville at
the time of their deaths but were well known in the com-
munity (one suicide victim and two overdose victims).
There were two additional deaths of young people, which
took place during this time, that were suspected of being
drug-related but were not reported as overdoses on the
death certificates.
All but one of the suicide victims were males and their
ages ranged from 16–24 years of age. Three overdose vic-
tims were females and the rest were male. While six sui-
cides and four overdoses occurred between 2000 and 2002,
five suicides and six overdoses took place between January
2003 and May 2005 (Figure 1).
According to state data, rates for suicide in 10–24-year-
olds during this time were substantially higher in Somer-
ville than statewide. The rate for Somerville for 2000–2005
was 9.77/100,000 compared to the state rate of 4.27/
100,000. Additionally, there was an increase in the Somer-
ville age-specific rates for suicide in 2000–2005 compared
Figure 1. Suicides and lethal overdoses among 10–24-year-olds, Massachusetts 1/1994–12/2007. Data source: Death
Certificate Data, City of Somerville 2001–2005.
88 K. Hacker et al.: Coping with Youth Suicide and Overdose
Crisis 2008; Vol. 29(2):86–95 © 2008 Hogrefe & Huber Publishers
to the previous 5 years, when the rate was 6.04/100,000
(1994–1999). Similarly, rates for opioid-related fatal over-
doses in this age group also exceeded state rates (Somer-
ville-23.2/100,000 in 2001 and 5.91/100,000 in 2004, com-
pared to statewide rates of 4.27/100,000 and 5.22/100,000;
respectively). For 2000–2005 the Somerville rate was
5.86/100,000 compared to the state rate of 4.36/100,000.
The rate for opioid-related age-specific overdoses in Som-
erville from 2000–2005 was also substantially higher than
during the previous 5-year period (5.86/100,000 compared
to 1.21/100,000). While we did not have statistical evi-
dence that the 2000–2005 suicides and overdoses repre-
sented a cluster, data certainly suggested elevated activity
(MassChip, 2006).
Hospital Discharge Data
State data for nonfatal self-inflicted hospital discharges and
opioid-related causes were reviewed from 1994 through
2006 for 10–24-year-old Somerville residents. Somer-
ville’s rate of hospital discharges for self-inflicted injuries
exceeded state rates in 2004 (130.5/100,000 compared to
the state rate of 76.4/100,000), which had not happened
since 1999. Opioid-related hospital discharges increased
substantially from 1994 to 2001 and continued to rise until
2004 when the Somerville rate was 706.0/100,000 com-
pared to the state rate of 269.2/100,000 (Figure 2) (Mass-
CHIP, 2007).
Teen Surveys
The teen health survey conducted in Somerville High
School provided pertinent information on student risk be-
haviors. From 2002 to 2004, the fraction of teens who had
considered, planned, and attempted suicide in the last 12
months dropped substantially. By 2004, percentages were
lower than statewide rates (Figure 3).
911 Call Data
The Somerville Fire Department agreed to share data on
911 dispatch calls for drug and alcohol overdoses and sui-
cide attempts involving 10–24-year-olds. This data, col-
Figure 2. Opioid-related hospital dis-
charges among Somerville residents
ages 10–24, 1994–2006. Data source:
Massachusetts Hospital Discharge
Database, MA Division of Health
Care Finance and Policy.
Figure 3. High-school students who
reported suicidal thoughts and behav-
iors in the last 12 months. Data
source: MassCHIP v3.00r3.13 of
January 2007, Somerville High
School 2002 (N= 1466), 2004 (N=
1382), and 2006 (N= 1003) health
surveys.
K. Hacker et al.: Coping with Youth Suicide and Overdose 89
© 2008 Hogrefe & Huber Publishers Crisis 2008; Vol. 29(2):86–95
lected by the dispatch desk, included the location, the rea-
son (drug, alcohol, or suicide attempt) for the call, and
the age of the person involved and was available starting
12/1/2004. Prior to this time, data were not kept in an
organized fashion and were, therefore, unavailable for
comparison. Once collected, data on 10–24-year-olds
were mapped using GIS (ArcGIS, 9.1) mapping software
as an overlay on the city grid. In addition, data were put
into a Microsoft Excel spreadsheet in order to look at
trends over time. The GIS map of suicides highlighted
the areas of the community most impacted by the events,
which informed prevention and intervention efforts (Fig-
ure 4).
Fire call data showed increased activity in nonlethal
drug overdoses during the months of July through Novem-
ber of 2004 and 2005 (Figure 5) while suicide attempts did
not demonstrate the same patterns. Overall, suicide behav-
iors were higher in 2004 than in 2005 but no clear year-to-
year patterns emerged (Figure 6).
Determining Contagion and
Identifying Those at Greatest Risk
To determine whether the current crisis reflected a conta-
gion, it was necessary to establish the relationships be-
tween known victims. Members of the coalition needed to
talk to victim’s family members and friends. This type of
postmortem assessment has been used in previous studies
of suicide (Gould et al., 1989; Shaffer, 1988; O’Carroll et
al., 2001). After initial attempts, it became clear that family
members did not want to discuss their losses with mental
health professionals. This was an important realization for
the professionals in the group. Several SCAP members
who were long-term Somerville residents and had relation-
ships with the impacted families were able to gather the
necessary information. While actual individual psycholog-
ical autopsies were not performed, information was gath-
ered about a group of deaths from different perspectives in
Figure 4. Suicide attempts and completed suicides among Somerville residents ages 10 to 24 years (N= 37 cases: 9 suicides
and 28 suicide attempts). Data source: 911 Fire Call Data, (01/04–12/05 and Death Certificate (01/01–12/05) data. Note:
One case when a Malden resident completed suicide in Somerville (2002) was included in mapping.
90 K. Hacker et al.: Coping with Youth Suicide and Overdose
Crisis 2008; Vol. 29(2):86–95 © 2008 Hogrefe & Huber Publishers
an effort to understand common threads. A leadership
group of coalition members, including mental health clini-
cians, school leadership, police, and several key communi-
ty parents, met weekly to review information on newly dis-
covered relationships between victims and their social cir-
cles. This mapping exercise helped create a picture of the
Figure 5. Nonlethal overdoses among Sommerville youth ages 10–24, 1/2004–12/2007. Data source: 911 Fire Call Data,
Fire Department City of Somerville, MA.
Figure 6. Suicide attempts among Somerville youth ages 10–24, 1/2004–12/2007. Data source: 911 Fire Call Data, Fire
Department City of Somerville, MA.
K. Hacker et al.: Coping with Youth Suicide and Overdose 91
© 2008 Hogrefe & Huber Publishers Crisis 2008; Vol. 29(2):86–95
crisis, including the families most impacted by the losses,
and the youth at highest risk for suicide and overdose.
It was discovered that youth were communicating about
suicide and overdose activity via internet sites (Somer-
ville’s Lost Souls, 2007). The legacy pages of the obituaries
(Boston Globe Legacy Pages, 2007) and several “my-
space” pages became places where loved ones and friends
paid their respects, memorialized those lost, and talked
about their feelings (Save our Somerville, 2006; YouTube,
2006). It was on these websites that the concerned adults
learned about additional connections between the victims.
While the use of the internet for social support has been
documented elsewhere (Whitlock, Powers, & Eckenrode,
2006), we have not found other reports of its use in episodes
of suicide contagion.
Based on their findings, the leadership group defined the
circles of influence that surrounded the victims; their family
members, their friends, and their peer group, and was able to
identify those who were most vulnerable. Via their connec-
tions in school and in the community, theywere able to reach
out to youth at risk and try to help link them to care.
Investigation revealed that 57% (12) of the victims of
suicide and overdose (four suicides, eight overdoses) were
connected to each other through friendship. The first of
these victims died in 2001. While two suicides occurred in
2000, there were no relationships established between them
and the victims that followed. One young man’s comments
at the 2007 Somerville Peace conference were particularly
poignant, “I entered high school in 2001 and by 2005, I had
lost 16 friends, acquaintances, or classmates” (McLaugh-
lin, 2007). It is quite possible that starting in 2001, as many
as 16 victims were part of a common peer group known to
be part of the “old” Somerville culture (referred to as “da
ville”): multigenerational families of white Northern Euro-
pean origin. While several of the deceased had moved to
neighboring cities and towns, they continued to associate
with their friends in Somerville. Investigation also revealed
that five individuals were connected through sports teams
(hockey, basketball), six of the nine suicide victims were
involved with substance abuse, and eight of the overdoses
involved heroin or other opiates.
The relationship between substance abuse and suicide
has been documented extensively in the literature (Hacker,
Suglia, Fried, Rappaport, & Cabral, 2006; Kelly, Cornei-
lius, & Clark, 2003; Garland & Ziegler, 1993; Wu et al.,
2004). In Somerville, this relationship was particularly
strong. Not only did a number of suicide victims engage in
substance use but the young people in the affected peer
group did not differentiate by mode of death. Rather, they
referred to all the friends they had lost. On several websites,
all those who were lost were named regardless of means of
death (including murder, illness, and accidental death). One
website called “Somerville’s Lost Souls” started with the
introduction, “This group is dedicated to the youth (anyone
under 30) of Somerville, MA. who died tragically before
their time.” (Somerville’s Lost Souls, 2007). Some 47
names were listed.
Intervention Steps
From 2003–2005, SCAP and ICH reviewed data and pre-
sented their analysis to the Mayor’s Suicide and Mental
Health Taskforce. With this information, the Taskforce
strategically planned and implemented a series of interven-
tions to prevent youth suicide and promote emotional well-
being. In keeping with the CDC recommendations, the
Taskforce leaders functioned as coordinators and facilita-
tors of the community-wide response, working with other
groups to maximize impact while identifying gaps that ex-
isted. Intervention activities were identified in several fo-
cus areas: support services, youth development, media ap-
proaches and education, and then resources were aligned
to achieve goals.
Support Services
During the early phases of the crisis, with guidance from
local experts, SCAP implemented a local Trauma Response
Network. Community members including parents, mental
health professionals, and teachers who were closest to the
young people impacted by the situation were trained in
posttraumatic stress management. These individuals were
then available to investigate traumatic events and their re-
percussions, attend wakes, funerals, and respond to youth
suffering from the impact of these tragedies. A trauma co-
ordinator was hired to facilitate and expand the network.
The network met throughout the crisis and continues to
meet regularly in the postcrisis period. To date more than
100 community members have been trained and main-
tained in posttraumatic stress management and over 20 in-
terventions have been conducted.
Simultaneously, other community-wide activities were
underway to increase awareness and drive prevention ef-
forts. A candle-light vigil was held to honor the deceased,
regardless of cause of deaths, in an effort to grieve the de-
parted without stigmatizing the manner of death. A sub-
stance abuse “speak-out” was held which allowed commu-
nity members to talk openly about the impact of substance
abuse on their lives and their community. Education forums
and trainings on the signs and symptoms of substance abuse
were held throughout the community and efforts were
made to reach out to the recovery community and link sub-
stance abusers with needed resources.
The schools, in collaboration with local mental health
agencies and the Trauma Response Network, provided cri-
sis counseling to students and their parents. In addition,
these agencies expanded school-based mental health ser-
vices and worked with staff and faculty to encourage refer-
ral and consultation as needed. The local hospital insured
that beds were preferentially made available for treatment
of Somerville residents and the emergency room monitored
activity and communicated with the network.
As the crisis progressed, coalition members identified
92 K. Hacker et al.: Coping with Youth Suicide and Overdose
Crisis 2008; Vol. 29(2):86–95 © 2008 Hogrefe & Huber Publishers
the need to offer support to friends and family members of
the victims. State funding was procured by a local commu-
nity mental health agency to reach out to known suicide
survivors and determine appropriate services. To date, 14
people have responded to recruitment strategies and helped
generate recommendations for the community.
Youth Development and Teen Leadership
Youth development activities were lacking in Somerville
and were seen as crucial ingredients for long-term support
of young people. Young people needed more positive op-
portunities for community involvement and leadership. In
2003, the Mayor enlisted the Center for Teen Empower-
ment to assess and make recommendations for improve-
ment of youth services in Somerville. These recommenda-
tions provided a framework for youth development in the
community (Center for Teen Empowerment, 2004). Subse-
quently, a series of efforts including a Youth Worker Net-
work, recreation programs, and after-school activities were
either launched or expanded across the city by various or-
ganizations and city departments.
Several organizations initiated programming in teen
leadership. These included the SCAP Youth Development
Leadership Program (YDLP; focused on empowering and
educating youth about substance abuse), the Somerville
Youth Council, and the Center for Teen Empowerment’s
youth leadership programs. One YDLP graduate went on
to hold a leadership role at both Teen Empowerment and
the Somerville Youth Program and recently cofounded his
own nonprofit named Save Our Somerville (SOS) while
another was awarded a community service award.
Media and Education Approaches
As part of the crisis response, Taskforce members met with
the editor of the local newspaper to discuss guidelines for
reporting on suicide based on the CDC recommendations
(CDC, 1994). These were adopted and resulted in nonsen-
sational reporting of deaths. Other media approaches in-
cluded writing a newspaper section for youth and families,
publishing prevention articles at holidays and anniversaries
of youth deaths, and creating a video for the local cable
channel called “Building Emotional Strength in Teens and
Families.”
Prevention efforts also took the form of broader commu-
nity education efforts. Funding was secured to hold a series
of workshops entitled “Caregiver Conversations” with
coaches, youth workers, and after school program leaders.
The workshops focused on enhancing adults’ abilities to
recognize suicide and substance abuse risk-factors and of-
fered information on referral resources.
Postintervention Data
According to death certificate data, Somerville has experi-
enced only one suicide and no fatal overdoses in 10–24-
year-olds since May of 2005 (Figure 1). The suicide victim
was a college student and had no relationship to previous
victims. Data collected from other sources also provided
evidence of decreasing suicide and overdose activity since
2005. Hospital discharge data for nonfatal self-inflicted in-
juries demonstrated a downward trend revealing that Som-
erville rates dipped below the state rate in both 2005 and
2006 (47.3/100,000 and 53.2/100,000 compared with
73.7/100,000 and 74.8/100,000 statewide). Nonfatal opi-
oid-related hospital discharges for Somerville residents
have also trended downward since peaking in 2004 (Figure
2). The 911 data continued to demonstrate a consistent an-
nual pattern in nonlethal suicide attempts and overdoses.
Overall, activity peaked in 2004 and has been diminishing
ever since (Figure 5). Lastly, the Somerville Teen Health
survey again showed decreasing rates of responses on sui-
cide questions in 2006 (Figure 3).
While the available data suggest that the interventions
conducted in Somerville had a favorable impact on con-
taining the contagion, it is impossible to know if there were
other factors responsible for the decline in suicide/overdose
activity. We can only examine pre- and postintervention
activity and speculate on the success of the community re-
sponse. It is also impossible to determine the impact of any
one individual activity on alleviating the crisis. It is likely
that the interplay of multiple strategies in multiple settings
amplified the effect of the various interventions.
Conclusions
There were a number of key ingredients that contributed to
the success of the community response in Somerville. First,
there was a level of community readiness and coordination
as evidenced by the existence of a strong coalition. SCAP
provided needed infrastructure for action and leverage to cap-
ture resources. It also provided a forum where various strata
of the community were represented: professionals, leaders of
local government, and activists with extensive ties to the por-
tion of the community most impacted by the crisis. Second,
political leadership was present. The new Mayor embraced
the issue and brought resources to bear for both suicide and
overdose prevention. Third, the relationship with a commu-
nity-based research organization, ICH, provided access to da-
ta. Data supported perception by identifying a public health
crisis. This allowed the community to ask questions, deter-
mine root causes, and plan accordingly. While these elements
catalyzed action and provided the “glue” for collaborative
efforts, a fourth element, the commitment and willingness of
various community agencies and individuals to provide vol-
untary resources to solve a community problem, cannot be
K. Hacker et al.: Coping with Youth Suicide and Overdose 93
© 2008 Hogrefe & Huber Publishers Crisis 2008; Vol. 29(2):86–95
underestimated. This collective action may, perhaps, be the
most important element in this or any other community re-
sponse to crisis.
The Somerville experience represents a community re-
sponse to a youth suicide and overdose contagion, but
would the community have responded similarly if the
young victims had been unrelated? In examining the early
phases of the response, when relationships of victims were
still unknown, it appears that the community would have
mourned, supported survivors, and moved on. It was the
contagious nature of the crisis and the associated urgency
that fueled a heightened community response and mobi-
lized the various partners in the manner described.
Statewide, Somerville has been cited as a model for
change on issues related to youth alcohol and drug abuse
(Moulton, 2005). While too many young people have been
lost prematurely, what remains is a trained and vigilant net-
work of public health professionals, agency directors, sub-
stance abuse and mental health clinicians, as well as a strong
cadre of community residents. Intervention, treatment, and
prevention leaders are working together more closely than
before the crisis and Somerville is a more informed and alert
community. Now, more than a year later, the community will
continue its efforts and build on its successes.
Acknowledgment
We gratefully acknowledge the members of the Mayor’s
Suicide and Mental Health Task Force, the Mayor’s Opiate
Prevention Task Force, and the Trauma Response Network
for their commitment and dedication to the youth of Som-
erville. Special thanks to Somerville Mental Health, Inc.,
The Family Center Inc., and The Cambridge Health Alli-
ance Department of Psychiatry, all of whom played espe-
cially significant roles during the crisis. In addition, we
thank Enkhbolor Myagmarjav, MPH, and Sandra Williams,
SM, who worked on surveillance, data mapping, and tables.
A special thanks also to Dr. Robert Macy and his team at
the Children’s Trauma Recovery Foundation. ICH ac-
knowledges the ongoing support of its collaborating hospi-
tals: Cambridge Health Alliance, Massachusetts General
Hospital, and Mount Auburn Hospital, without which this
work would not be possible. Finally, we acknowledge the
families and friends of all those who passed away during
this crisis and offer our sympathies and support.
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About the authors
Karen Hacker, MD MPH, is an internist and specialist in adoles-
cent medicine. She is the Executive Director of the Institute for
Community Health, a community-based research organization,
and an Assistant Professor of Medicine at Harvard Medical
School, Boston, MA, USA. She has over two decades of experi-
ence in public and community health implementing programs and
conducting community-participatory research.
Jessica Collins, MS, was the Somerville Health Agenda director
serving as a liaison between Somerville and the Cambridge Health
Alliance. She also has extensive experience working in obesity
prevention from both a programmatic and research perspective.
She is currently Director of Community Benefits for Bay State
Hospital.
Leni Gross-Young, MA, LMHC, has worked in social services for
over 24 years and in Somerville for the last 3½ years. She has
extensive experience in trauma-related issues and led the trauma
response network in Somerville. She continues to consult the
Somerville Health Department on mental-health-related issues as
well as various community programs focused on suicide preven-
tion.
Stephanie Almeida is a substance abuse prevention specialist.
During her years with Somerville Cares About Prevention, she
organized the mayor’s Opiate Prevention Task Force and was in-
strumental in raising awareness about the opiate problem in both
Somerville and statewide. She is an advocate and is actively in-
volved in the substance abuse recovery movement. She currently
works in North Carolina.
Noreen Burke, MPP, is Director of the Somerville Health Depart-
ment. She previously worked as the Somerville Health Agenda
director and as Director of the Human Rights Commission for the
City of Somerville. She has been committed to community health
improvement for more than 10 years.
Karen Hacker
Institute for Community Health
163 Gore Street
Cambridge, MA 02141
USA
Tel. +1 617 499-6681
Fax +1 617 499-6555
E-mail khacker@challiance.org
K. Hacker et al.: Coping with Youth Suicide and Overdose 95
© 2008 Hogrefe & Huber Publishers Crisis 2008; Vol. 29(2):86–95
