Grim news hit this university town in late October just two days before a PTA forum on teenage stress: A fourth Palo Alto teen had died after stepping in front of a commuter train in less than six months.
With hundreds of parents crowding the forum, school Superintendent Kevin Skelly told the anxious gathering that the latest death was "a cruel irony" because city officials were working to prevent another tragedy.
Experts have struggled to understand what generates clusters of teen suicides, a phenomenon that breaks into a community's awareness when they occur in a public place, as they did in Palo Alto. But officials in this San Francisco peninsula city of about 59,000 say they're deploying a wide array of approaches to stop it from growing.
Those efforts are moving with greater urgency since the most recent suicide on Oct. 19 that involved a 16-year-old male student at Henry M. Gunn High School. Two other Gunn students, a 17-year-old boy in May and a 17-year-old girl a month later, also took their own lives on the train tracks. A 13-year-old girl died the same way in August, days before she was to become a Gunn freshman. At least one Gunn student, another 17-year-old boy, was prevented from killing himself in June after his mother followed him to the tracks.
"There is no single answer. There is not necessarily a cumulative set of answers either," said Greg Hermann, a spokesman for Palo Alto, which convened a task force of psychologists, clergy and others to prepare a response plan. "There are intelligent steps we can be taking."
Police patrol the tracks while city officials negotiate with the railroad on a design to make them less accessible. Students are discouraged from erecting shrines at the sites, which might romanticize the deaths, and the media has been asked not to make public those locations.
Some of the high school's 1,900 students also have created T-shirts with the message "Talk to Me" and formed pacts not to harm themselves. One student left bracelets made of heart-shaped walnut shells for others in need of cheering up to find. A group posts optimistic notes around campus.
Joyce Liu, a 17-year-old senior, created a peer-run support group that staffs a table during free periods and hosts a social networking site where classmates can find someone to listen. She also created a Web site called "Henry M. Gunn Gives Me Hope," where teachers and students share random acts of kindness and beauty that have come their way.
"A lot of the time, the problem is no one really knows the exact reason why someone would step on the tracks," she said. "People keep on searching for answers, but sometimes you won't ever really know because the person is not here anymore."
Vastly different communities that have been in the same situation also had valuable lessons to offer. One that resonated deeply in Palo Alto was that suicide can be contagious and should be treated as a public health crisis.
Merily Keller, a founder of the Texas Suicide Prevention Council, tried to "prevent a downward spiraling of grief" when her 18-year-old son became the fifth and last boy to die in a suicide cluster in Austin, Texas, in 2000. She and her husband buried him at a family ranch so his friends could not gather at his grave site without adult supervision.
"One of the biggest risk factors is knowing another kid who has died by suicide," said Keller, who described that particular warning sign as having "a different quality."
"It's like juggling something -- if you have too many risk factors, they are going to crash," she said.
Suicide is the third-leading cause of death among people between the ages of 15 and 24 in the United States, according to the Centers for Disease Control and Prevention. But school, social stress, romantic problems or even having a classmate who died by suicide are rarely big enough triggers alone to cause a teenager to end his or her life, said Madeline Gould, a Columbia University psychiatrist. She found evidence of 50 suicide clusters nationwide between 1987 and 1996.
The clusters, which resulted in about 200 deaths, constituted 2 percent or fewer of all youth suicides during that period, she said.
"These poor kids died from an untreated psychiatric illness, or undertreated. It's not as if it's a mysterious thing and it's not as if it's not preventable," Gould said. "Unfortunately, there is the misconception that if someone wants to die by suicide, it's inevitable. That's not the case. The impulse to kill yourself waxes and wanes."
Alex Crosby, a CDC epidemiologist, said not enough research has been done on clusters to know why the deaths stop. Is it due to intensive responses like the one in Palo Alto, "or did they run their own course and go away because maybe some of the already vulnerable folks had been susceptible?" he said.
In Palo Alto, experts from the children's hospital at Stanford University are advising administrators, teachers and parents on how to recognize depression. Counseling requests from students are up threefold, and schools are looking into making psychological screening of students routine.
Among other gestures to show support to students, teachers at Gunn have canceled quizzes, given out their home phone numbers and held classes outdoors.
The outreach also has prompted parents such as Terry Godfrey, president of the Palo Alto PTA Council and the mother of a 10-year-old boy and a 12-year-old girl, to hug their children more, to think about instilling coping skills and to have dinnertime conversations they never expected.
"Our community is reeling. We love our kids and unfortunately, we've learned a lot about death by suicide," Godfrey said. "One of the things I've learned in the last couple of months is that you should ask your kids very directly, 'Would you consider suicide?' My kids roll their eyes at me and say, 'Mom, of course not.' But I have to ask."