Caltrain and communities in the South Bay have been working for several years to send a simple, compassionate message to anyone who may be in psychiatric crisis near the train tracks: "There is help."
It's written on signs dotting the tracks near Caltrain intersections and stations, with a crisis hotline number under it. South Bay transit police with crisis intervention training intervene in dozens of potentially lethal incidents every year. The system has added 62,000 feet of fencing and formed partnerships with local and national suicide prevention organizations.
And while the number of deaths by suicide on the tracks started a downward trend in 2011, tragedies in 2015 have been frequent. When a 15-year-old Palo Alto High School student died Monday, the number of deaths by suicide on the system's right of way in 2015 climbed to seven, one more than all of 2014.
Most suicides on Caltrain tracks happen between South San Francisco and San Jose, with the greatest concentration in and around Palo Alto, according to a 2010 study for the state Department of Transportation. The fatalities often end the lives of young people. Since 2005, 10 teens have died by suicide on Caltrain tracks, with two this year, according to the agency. It's frustrating and frightening for people in the South Bay.
"It tells us we have to keep working at this," said Stephen Kaplan, director of San Mateo County Behavioral Health and Recovery Services. "We have to extend our reach. We have to make treatment accessible to people."
Suicide is often precipitated by an underlying mental illness, often depression or some form of anxiety, according to all the mental health experts interviewed for this report. Those conditions are common, and they are treatable.
"What you’re experiencing is something many people experience," Kaplan said he would tell someone showing the signs of potential suicide. "There’s help available and people get better. Encourage them to access the hotlines or crisis lines, or online links to talk with somebody."
Source: Caltrain and MTI report for the state Department of Transportation
To Meg Durbin, a physician at Palo Alto Medical Foundation, part of the dilemma is that prevented suicides are rarely, if ever, reported. She mentioned a program called "trackwatch," where volunteers keep an eye out at some intersections in Palo Alto for people who may be considering harming themselves.
"They are trained to respond to emergencies and to respond to distress," she said. "It has worked. We have saved lives with this."
South Bay transit police successfully intervened in 91 potentially suicidal incidents between 2010 and 2013, according to data provided by Caltrain. Durbin said Palo Alto schools have several response plans in place to minimize the impact on other students when one of their classmates dies. That includes counselors checking in with students who may be vulnerable, a practice Durbin said has identified students in crisis and facilitated treatment.
"Interrupting a person’s progression around suicide thinking to acting is really important," Kaplan said. "If you can interrupt that and provide them with appropriate resources at that time, you have a pretty good chance."
As deaths by suicide, especially those of teenagers, continue to hit Palo Alto high schools, another concern has emerged: suicide contagion, or clustering. A suicide cluster occurs when a number of suicides occur close in time and location, or when one suicide appears to foster the next, Durbin said.
"We’re in one," she said. "There is no doubt we’re in one."
News coverage can play a role in deepening a cluster, according to Caltrain and mental health experts. In reporting a suspected suicide, Caltrain includes guidelines for reporters developed by national suicide prevention organizations and urges caution.
"We believe that it is very clear that media coverage of these suicides, particularly in Palo Alto, has exacerbated the problem," Caltrain spokeswoman Christine Dunn said.
A Santa Clara County mental health professional reached for this story, who asked not to be quoted by name, said she always encourages reporters to drop any story involving suicide because of the risk of contagion. She said some do.
To Durbin, it isn't that clear-cut. She said reporting that glorifies suicide, gives extensive details of the manner and means of a death, or focuses on memorializing the deceased can put vulnerable people at risk. But she said the news media can play an important role in educating the public on risk factors for suicide and resources available.
Kaplan said combating stigma around mental health care is one of his highest priorities in the effort to reduce suicides.
"We have to normalize this," he said. "We have to get people to know that treatment does work, and it is available."