Youth Suicide and Mental Illness: A National Tragedy Hits Home

Locals have rushed to provide support and treatment for teens in Transylvania County after three student suicides last year and amid soaring national rates of emotional distress among young people.

Billy and Keri Zink on the back porch of their home in Cedar Mountain, flanked by a sculpture bearing an uncanny resemblance to their daughter and dried flowers from her memorial service

CEDAR MOUNTAIN — Think of what parents can do to raise a healthy, happy kid, and, pretty much, Billy and Keri Zink did it.

Exercise? They encouraged their youngest child, Ellery Zink, to get into swimming, rock climbing, backpacking, and, after her mood darkened with the onset of puberty and the Covid-19 pandemic, lacrosse.

“We found lacrosse and she loved it,” Keri Zink said. “And that’s what made me feel, oh my gosh, we’re heading in the right direction.”

Social engagement? Ellery made friends on the lacrosse team, and as a pioneering female member of a Boy Scout troop her mother led as scoutmaster — and at Rockbrook Camp for Girls, where her parents sent Ellery every summer starting when she was a small child.

“She could just walk up to random people and start having conversations with them,” said Josie Saunders, her closest friend from Rockbrook. “She was one of the most social people I knew.”

When Ellery came to her parents in February of 2021 to say she was struggling emotionally, they listened, signing her up for sessions with a psychiatrist and a therapist.

And to limit access to social media, her parents required Ellery and her two older brothers to deposit their cellphones in the dining room before they headed to the lower floor for bed.

Keri Zink was trying to enforce this rule last Aug. 24, when, shortly after 10 p.m., she noticed that Ellery’s phone wasn’t at its designated night-time spot on the sideboard. She walked down to her 14-year-old daughter’s bedroom to retrieve it and found her dead.

“She had hung her hammock strap off her pull-up bar and was obviously on her knees when she put it around her neck and kind of leaned forward into it,” Billy Zink said.

They can never know whether Elllery, who didn’t leave a note, intended to commit suicide or just experiment with it. But beyond that, they face a question that mirrors one that looms over Transylvania County and communities all over the county:

Why did such a promising and beloved girl as Ellery feel such profound lack of hope? Why do so many other young people feel the same way?

Ellery was the first of three Transylvania County Schools students to kill themselves during the last school year — more teenage suicides than in the previous 15 years combined, according to a comprehensive 2021 report on community health in Transylvania. Before the end of the first semester of last school year, the district performed 54 additional suicide assessments of children showing signs of being at risk.

Nationally, the rate of teenagers reporting “persistent feelings of sadness and hopelessness” has been climbing for more than a decade and reached a new high of 44 percent during 2020, according the federal Centers for Disease Control and Prevention.

The CDC also found that 13 percent of adolescents reported a major depressive episode in 2019, a 60 percent increase since 2007. During roughly that same period, suicide rates in that age group climbed by an identical rate. And in December, the U.S. Surgeon General warned of a “devastating” adolescent mental health crisis.

“Over the past couple of decades, when suicide has killed more individuals between the ages of 15 and 24 than the next seven medical causes combined, I think we clearly have to look at this as a crisis,” said Nathan Copeland, a child and adolescent psychiatrist and assistant professor at Duke University.

“The pandemic probably just turned the temperature up, but we were already moving to a crisis if we weren’t already in a crisis.”

The source of this pain is especially elusive because rates of so many traditional threats to adolescent well-being — drug use, binge drinking, arrests and pregnancy — are in long-term decline.

The social destruction left by the opioid crisis and the isolation of the pandemic almost certainly play significant roles, as does, probably, the increasing use of social media, said several people interviewed for this story. Maybe it’s political divisiveness and obstacles young people see to rewarding futures, including high costs of education and housing.

The evidence is clearer on what needs to be done in schools and communities, some of which has been done in Transylvania.

Though gaps in treatment remain, schools have added counselors, increased access to therapists and encouraged emotional support from teachers. TC Strong, a community group formed last year in the wake of the suicides, has worked to create a more seamless network from the notoriously fragmented providers of care.

And, in what experts such as Copeland say may be the most crucial step, the organization has pushed for public discussion of youth mental illness.

“We have to be talking about this,” said TC Strong Coordinator Rik Emaus. “We have to find ways to do better together, to help our youth feel like we care about them, we love them, we’re trying to do something to help them.”

“That’s kind of been our approach all along,” Billy Zink said of his and his wife’s response to Ellery’s death. “We’re not here to whitewash it or sugarcoat it. And if it can help one other person who is in a similar boat, then the difficulty of discussing it is well worth it.”

The World Wide Web or the Wider World?

TC Strong slide based on data from the federal Substance Abuse and Mental Health Services Administration

No evidence directly links online activity to increasing rates of emotional distress, Copeland said, and none of the students interviewed for this story said they felt dragged down emotionally by social media.

Just the opposite, said Johnathan Meeks, a rising senior at Rosman High School, who found online communities that gave him the strength to come out as gay and find his political footing as a liberal in a conservative community and family.

Meeks, a TC Strong youth delegate, brought his grades up dramatically last year and, at this year’s session of the American Legion’s Tar Heel Boys State, was one of two Senators selected to represent North Carolina at a national Boys State gathering.

Encouraging online voices “gave me the foundation to build on with those other activities I mentioned,” he said.

But Emaus, a retired family physician and the father of seven adopted children, sees a clear correlation between declining mental health and the rise of internet access.

Reports of major depressive episodes and severe emotional impairment among adolescents “have taken a really profound upturn since about 2012, which is the general time when smartphones and internet access became available to that age group,” he said.

And theories about the harm caused by social media, if not proven, are surely plausible, psychiatrists and psychologists said.

Virtual connections can replace more rewarding face-to-face time with peers and adults, said several people interviewed for this story. Social media use can interfere with much-needed sleep, expose children to cyberbullying and bombard them with unattainable, idealized versions of their friends’ lives.

What is undeniable about the online landscape is its vastness, Copeland said, and the instant availability of countless messages, good and bad, clearly warrants adult guidance.

“I think it’s very fair for parents to have oversight into how their kids are doing (online),” he said. “Social media is not a right, it’s a privilege.”

Hazel, a pseudonym chosen by a registered nurse in the county to protect the medical confidentiality of grandchildren in her care, agrees: It’s not that all messages on social media are destructive. There are just too many of them for children to handle alone.

“I guess they don’t know what to do with all the information they are receiving,” she said.

The problem is not only this expanded view of the world, but the state of the world it reveals, said Evelyn Chiang, a professor of psychology and co-director of the Center for Teaching & Learning at the University of North Carolina Asheville.

“Kids are growing up in vastly different times than when I was growing up. We did not have cellphones. We did not have the internet. We did not have school shootings. We did not have as much gun violence and there was no January 6th insurrection,” she said. “There’s a lot of chaos in this country.”

There’s also, seemingly, less opportunity, Meeks said.

“Life isn’t as self-sustainable as it was several decades ago,” Meeks said, speaking of obstacles to housing and education, especially for minority students.

“It’s hard to develop the independence that kids really seek,” he said, “and I think that plays into the mental health of people my age.”

Opiods. And then Covid

But Hazel sees a more direct cause of the emotional struggles of her grandchildren, one scarcely mentioned in some reports about the crisis: the opioid epidemic.

Though overdose deaths in Transylvania peaked in 2012, abuse of other drugs as well as opioids — including the increasingly common and highly lethal fentanyl — continues to devastate families, said Kristen Gentry, program director for the CARE Coalition of Transylvania County.

The 2021 county health report, for example, found 28 percent of local residents had been exposed as children to family substance abuse, recognized as one of the “Adverse Childhood Experiences,” or ACEs, that the CDC identifies as proven causes of long-term emotional turmoil and destructive behavior.

Addiction can also lead to other events on the ACEs list, including the loss of a parent. One of Hazel’s daughters, the mother of two of the children she is rearing, died of an overdose, as did the father of another two kids in her care.

Hazel’s other daughter, the mother of three of her grandchildren, also struggles with addiction and has been absent for most of their lives, while one of the children’s fathers is in prison on drug-related charges.

Three of the grandchildren also lost a younger sister to sudden infant death syndrome, and Hazel’s mother died suddenly in March.

“These kids have had lots of loss,” she said. “Lots of loss, lots of trauma.”

Still, they were good students and engaged in extracurricular activities until the start of the pandemic, she said. “I think Covid gave them time to think and just compounded everything and kind of brought everything to the front.”

Her grandchildren have all been diagnosed with post-traumatic stress disorder and are on at least one medication. And two of her teenage granddaughters have been repeatedly hospitalized after suffering mental health crises.

The younger girl has twice attempted suicide, most recently in March.

“You have a girl who tells you she doesn’t see a future for herself . . . She says, ‘I don’t think I’ll be alive when I’m 30,’ ” Hazel said.

“What do you do, other than say ‘I love you and I don’t want you to die.’ ”

The Search for Treatment

And try to find help, which Hazel has been doing for years.

All of her grandchildren qualify for Medicaid because of their parents’ circumstances, she said. They have been able to talk to counselors at school, receive ongoing therapy through the Hendersonville-based, publicly funded nonprofit, Blue Ridge Health —which merged with Meridian Behavioral Health Services last year — and treatment by physicians at a private practice, Hendersonville Pediatrics. 

The hard part has been finding inpatient and intensive outpatient care.

In March, one of her granddaughters stayed six days at Transylvania Regional Hospital, receiving only brief daily visits from a psychologist and virtual sessions with an out-of-state psychologist. With no beds available at the Copestone psychiatric unit at Asheville’s Mission Hospital, the girl was released to her home.

(Nancy Lindell, the director of public and media relations for Mission Health, which also owns Copestone and Transylvania Regional, did not respond to a request for comment.)

Because of the same shortage of local beds, Hazel’s younger granddaughter was forced to seek treatment at a facility in Winston-Salem after her most recent suicide attempt.

Especially because the girls have begun to resist attending counseling sessions, the family needs the kind of intensive outpatient care — home visits by a therapist at least twice a week — provided by, among other groups, Youth Villages and Access Family Services, national agencies with offices in Asheville.

It’s the only hope to address both her granddaughters’ acute needs and the struggles of her younger grandsons, who are increasingly modeling the girls’ behavior.

“Everybody’s mental health is like this,” Hazel said, intertwining her fingers in front of her. “Our home has always been chaotic but it used to be a joyful chaos and that’s what I miss and that’s what I feel they need. I’d like to have some joy back in my house and right now there’s just none.”

She has been requesting intensive family counseling since March, after both granddaughters were hospitalized. The Department of Social Services (DSS) has also been seeking help on her behalf.

She received an appointment for an in-person intake session with Youth Villages only this week, when she learned that her family would be accepted for treatment. She also learned it won’t start for another two months.

“Wait times have been horrible” for such services, said Elizabeth Conway Williams, a psychologist with Hendersonville Pediatrics.

An office manager at Access Families in Asheville confirmed backlogs of up to a year for intensive treatment from its therapists. Craig Cannon, a senior public relations coordinator for Youth Villages, pointed to unspecified disruption in service providers in Transylvania and the surge in cases.

“Demand for mental health services for children and youth are at an all-time high,” he wrote in an email.

If so, Hazel said, available services should keep pace.

“There are a lot of groups out there that say they want to help, but I don’t think there are enough boots on the ground,” she said. “DSS keeps saying, ‘Hang on, help is on the way, but I’m still hanging on.”

Refrigerator magnet that, Hazel says, gives her strength to persevere (Contributed photo)

School and Community

The intensive assistance Hazel is waiting for relies on factors such as state and federal funding that locals can advocate for but not control, Emaus said. So the school district and TC Strong are focused on providing help to young people before they develop such acute needs.

“It’s simply a community collaborative that endeavors to bring the schools and the community together to make sure that whatever resources we have are available to our kids,” Emaus said of his group.

Its members include students, school administrators and representatives from service providers. Williams, a TC Strong clinical therapist delegate, is working on what she calls a “passion project” for the group — developing a widely available, easily updated spreadsheet to coordinate mental health services that have too often operated independently.

Schools, with the help of federal Covid-19-relief funding, hired an additional counselor last school year at both Brevard Elementary and Brevard Middle schools, said Missy Ellenberger, the district’s director of high school curriculum, student support services and safe schools.

Another counselor is due to return from maternity leave next school year and the district has used outside funding sources to hire two more counselors.

Along with providing academic guidance, counselors are trained to address students’ mental health concerns, Ellenberger said. Students who need regular therapy can receive it from Blue Ridge licensed clinical social workers now stationed at schools in the district.

When students returned to in-person learning last fall and “everybody was really struggling,” said Barbara Grimm, principal of Davidson River School, “I felt incredibly supported by both the district and the mental health providers.”

The Role of Teachers

Teachers can also have a big role in bolstering student’s mental health, and should maybe take a bigger role, said Brevard High School honors English teacher, Josh Tinsley.

Based on conversations with students and responses to surveys he has sent home with them, he said, “Kids don’t feel as if they are being heard.” Teachers, he said, need to make sure they are.

This means not telling students to toughen up, which just encourages them to avoid feelings that need to be addressed, he said. “There is the old idea that . . . when we were kids we were told to suck it up and it worked out fine, and that’s absolute nonsense.”

Similarly unhelpful is “toxic positivity” — telling young people that, really, they have it pretty good.

“ ‘At least you have a mom,’ ‘At least you have clothes,’ ‘At least’ —  whatever it is that denigrates a person’s feelings of difficulty,” he said. “When somebody expresses pain and struggle, you never start your response with ‘at least.’ ”

What teachers should do, he said, is start classes by asking students how they feel “and really mean it,” he said. “Just try to connect with them in a meaningful way.”

Since the start of the pandemic he has also made a point of telling kids he loves them, he said. “Not ‘I care for you,’ not ‘Brevard High School loves you.’ No, ‘I love you.’ ”

“I’ve seen a real shift in their relationship with me . . . a dramatic change,” he said. “I have kids with a much greater willingness to be vulnerable in front of the class, and I think that’s a big deal for them.”

Teachers are already overburdened, he acknowledged, and not every subject is like literature, which can lead naturally to students’ discussions about emotions. Not every teacher feels comfortable being as open as he is.

And while teachers’ support is essential, it has limits, Ellenberger said. Teachers are trained as educators, not counselors, who are the ones equipped to handle serious mental health concerns, she said.

“We strongly encourage teachers to build relationships with students,” she said. “But those relationships need to help teachers get students the help they need.”

And when incoming Brevard High Principal Scott Strickler offers love to students, he said, he makes it clear it is in the context of ensuring their basic needs are met, a prerequisite for effective learning.

“I tell them I love them as a principal, which I mean very differently than when I tell my wife and kids I love them,” he said. “But the sentiments are similar. I care about you. I care about your well-being. I care about your safety. You have a voice here.”

The “Chemical of Love”

Students such as rising Rosman High junior Trinity Wilbanks, above, said they appreciated the openness of teachers and counselors last school year.

However support is expressed, students felt it from teachers and counselors after the suicides last year, they said. And it helped.

Before last year, Meeks said, he is not sure he could have told teachers he was gay, and he wouldn’t have known it was something he could talk about to counselors.

“Ever since Covid, or post-Covid really,” he said, “it’s a completely different batch of teachers. Not literally a different batch, but different in personality and approach to classroom instruction and engagement.”

Trinity Wilbanks, another TC Strong delegate from Rosman High, said some students are reluctant to share with adults for fear of being judged. Which makes it all the more important to form connections such as the one she built with her chorus teacher.

During lunch or free periods, “I would just walk into her classroom so I could talk about whatever was happening in my day and needed to get off my chest,” said Wilbanks, a rising junior.

“She would listen. She would give me feedback. She was always willing to help me no matter what.”

“I think what you’re talking about with (Brevard teacher) Josh Tinsley is very important because we don’t always realize how simple, nice things can completely change people’s days,” Meeks said.

“A simple, kind gesture, if it isn’t manufactured, can totally improve my day for the better. It’s like being on a dopamine high, the chemical of love.”

And when Dylan Zink, who graduated from Brevard High last year, slowly returned to school after his sister’s death, he started by attending Tinsley’s yearbook class.

This was partly out of duty; he was one of the editors and Tinsley is the faculty advisor. But also, Dylan Zink said, “it was just an easier space to go back into.”

“Spicy Little Meatball”

A 2021 photograph of Ellery Zink provided by her family

The benefits of open communication between teens and adults may be the clearest lesson Ellery’s parents took from her death.

They have been disturbed to learn that some of Ellery’s friends didn’t share all they knew about her struggles. But they have also been comforted by staying close to young people who knew Ellery, who appreciated her rich and intense personality.

She was “the sweetest person ever,” said Josie, who remembers receiving “just the warmest hug” from Ellery when she first arrived at Rockbrook from her home in California as a young, scared girl.

But she also remembers Ellery pushing her out of a tree, intentionally flipping their canoe on an overnight trip and “on that same trip, she said, ‘I have a present for you,’ and she picked up a wolf spider and threw it into the canoe,” said Josie, 15. “I loved everything about her even if she was the bane of my existence sometimes.”

Ellery was so compassionate that she relentlessly lobbied her parents to adopt a fifth-grade classmate being raised in a foster home, her mother said. She was bold and thrill-seeking. “We were always, like, ‘Watch Ellery, she’s going to climb that mountain.’ And she would do it,” Keri Zink said.

She was “very creative,” spending hours in the pottery studio with her grandmother, Judith Duff, a well-known ceramicist, and trying to fashion a homemade wingsuit after watching a documentary about BASE jumpers soaring off mountain peaks.

She was short for her age, but athletic and strong — and, even as a young girl, rebellious and impulsive, her mother said. “She had a nickname, ‘Spicy Little Meatball.’ ”

“She could go from the lowest of lows to the highest of highs at the snap of a finger,” Billy Zink said.

They noticed more lows at the end of her seventh grade year, with the start of the Covid-19 pandemic.

She argued and severed ties with close friends. She started to spend less time outdoors and more time holed up in her room, surrounded by dirty dishes that she refused to wash. “She definitely got sucked into social media,” her mother said.

In eighth grade, on a hybrid-learning schedule at school, her once-excellent grades plummeted along with her self-esteem. “When I would try to help her she would say, ‘You just don’t think I’m as smart as the boys are,’ ” her mother said. “She started feeling bad about herself.”

Ellery was able to tell her parents that she needed treatment in February of 2021, and as these sessions progressed they saw signs of hope in lacrosse, in a Boy Scout trip she took to New Mexico last summer, and in her session at Rockbook.

She ate dinner with the family the evening of her suicide and, for the first time in weeks, gave both parents a hug.

“She presented to us that everything was going fine,” Keri Zink said. “We didn’t realize the depth of her pain.”

But some of her friends did, said Keri Zink, who was shocked by how many of them later told her that her daughter routinely talked about self-harm.

“It was like, ‘I’m depressed. I’m suicidal. Let’s go get coffee’ . . . like it’s just a trivial conversation,” she said. “Nobody took it seriously and that’s a huge problem to me.”

The same rule that applies to signs of abuse should apply to talk of suicide, said Billy Zink, a physician’s assistant.

“If you see something, say something.”

Trying to Heal

He has dealt with his grief by trying to accept that he will never be able to fully understand Ellery’s death, and by throwing himself into work on the job and at home.

“Groceries had to be bought. Things had to be done. I guess that’s just my nature,” he said.

Keri Zink took the opposite path.

She spent hours searching Ellery’s phone for signs of bullying — there were none, she said — and for clues to her motives. For two months, Keri Zink hiked the woods around the family’s isolated home in Cedar Mountain before she found the spot where Ellery had posted a picture of herself smoking the afternoon before she died.

“I was obsessed with it,” she said.

She has ruminated over forces that might have contributed to her daughter’s decline, including the death of Ellery’s beloved grandmother, Duff, of dementia in March of 2021, and the powerful effect of hormones as Ellery entered adolescence. It’s an underappreciated factor in the mental health of teenage girls, her mother said, and caused Ellery’s frequent migraines and contributed to her profound mood swings.

But with the help of a therapist, Keri Duff also asserted her need to rest, to take time off from her demanding job as an architect, to not answer every text, to sit for hours soaking up the peaceful surroundings on her back porch.

“A good day for me is when I can do nothing,” she said.

Though some people don’t understand, she said, it has helped to be surrounded by reminders of her daughter. A basket in the dining room overflows with cards and letters received after Ellery’s death. Dried flowers from her memorial service hang from a beam on the back porch.

In the weeks after Ellery’s death, Keri Zink sometimes slept in her daughter’s room, with its Grateful Dead poster, a shelf packed with empty energy drink cans and a ground-level view of the nearby forest.

“Some days I can’t bear to go into her room and other times I want to,” she said. “Some days it’s comforting. It’s the only way I can feel close and remember when she was that spicy little meatball.”

For teenagers (or adults) experiencing suicidal thoughts, the national suicide hotline is 1-800-622-HELP. To learn more about local mental health resources, click on TC Strong’s website, which also includes a help line.

Email: brevardnewsbeat@gmail.com