The bishop's office might be the first stop for a depressed or suicidal teenager in the LDS Church.
Parents see the ecclesiastical leader of the local ward as someone who can "fix" their child's emotional problems. But while bishops can offer spiritual guidance and some practical advice, they are not psychologists.
And they should not be expected to take on that role, says Elder Alexander Morrison, an emeritus general authority of The Church of Jesus Christ of Latter-day Saints. "They should not try to treat mental illness themselves," he said.
Just as people don't hesitate to consult a physician about medical problems such as cancer, heart disease or diabetes, they should not hesitate to obtain appropriate professional assistance for mental illness, he said.
Mental illness, particularly depression and bipolar disorder, are common among young people who take their own lives.
Several parents and mental health professionals interviewed for this series, "Teen suicide: Utah's grim reality," wonder whether the LDS Church's high expectations for young people may contribute to depression and suicide.
"I am an active, believing member of the LDS Church," said a Utah Valley mother who did not want her name used. "But I cannot deny that the culture of high expectations this belief system generates around itself can be so deadly to its youth."
Depression runs in her family, and she said she is especially concerned because her 11-year-old son is entering "those years of precarious dips and peaks of emotion."
There's pressure to "live worthy," said Utah Attorney General Mark Shurtleff, an LDS father of five.
Latter-day Saints are counseled to avoid premarital sex, pornography, drugs and alcohol, among other things. Young men and women are taught to live clean lives to prepare for missionary service and marriage in an LDS temple. Those who make a mistake or fall short might lose self-esteem or fall into depression.
The LDS Church helps teenagers deal with life's challenges through weekly spiritual instruction, wholesome group activities, adult mentoring and personal interviews with congregational leaders, according to Fred Riley, director of LDS Family Services.If a teenager is struggling and needs help, parents and youth leaders can work with their bishops to get professional help, he said in a statement.
Doug Gray, a University of Utah child psychiatrist, said culture does play a big role in Utah's suicide rate but couldn't say it is exclusively attributable to religion.
Rocky Mountain states have a 30 percent higher rate than the rest of the country, he noted. Westerners' independent nature and the availability of guns have something to do with that, he said.
A Brigham Young University study published in the American Journal of Epidemiology in 2002 found that 60 percent of suicides in Utah for 15- to 34-year-olds were committed by male members of the LDS Church.
Nevertheless, the risk of suicide in that age group was lower among active Latter-day Saints than among less active members, nonmembers and American males in general, according to the report.
The BYU researchers concluded that even though Utah is predominantly LDS, there is no evidence to suggest demands and pressures on church members contribute to the state's overall high suicide rate.
LDS Church leaders have long been cautious in their remarks regarding how members should deal with emotional and mental problems, often suggesting spiritual counseling with church leaders, priesthood blessings and personal devotion rather than medication or professional counseling.
Elder Morrison, whose book "Valley of Sorrow: A Layman's Guide to Mental Illness" grew out of his daughter's struggles, and other former LDS general authorities have attempted to bring more openness to the topic. His book includes a chapter on suicide.Last October, the church's Ensign magazine published an article written by Elder Morrison titled, "Myths About Mental Illness." He makes it clear psychological disorders are not a reflection of sin.
Bishops receive no formal training on counseling members with mental health concerns or suicidal thoughts.
"There is a void," said Rick Hawks, a psychologist who organized the Mental Health Resource Foundation in Ogden. "Bishops do the best they can, but they don't have a lot of resources."
About three years ago the foundation, whose board includes several former LDS general authorities, took it upon itself to provide information on suicide and mental illness from a Latter-day Saint perspective. It makes available on the Internet (mentalhealthlibrary.info) materials produced by LDS Family Services that previously were accessible only to mental health professionals.
"Every problem that exists in a mental health clinic now exists in a typical ward," Hawks said. "That's a scary thought."
If a new disease started taking hundreds of young lives, there would be a huge outcry, he said, but "with suicide and teenagers we accept it just like a car accident."
As an institution, the LDS Church has said little about suicide over the years.
What was then called LDS Social Services published a booklet for local lay church leaders in 1974 titled "Identification and Prevention of Suicidal Behavior." It includes warning signs, a list of do's and don'ts and suggests seeking professional help for the member.
LDS Church spokesman Dale Bills said he was not aware of any new publications specific to suicide since the pamphlet was published 32 years ago.
In recent years, LDS Family Services has offered seminars on depression and suicide for stake presidents and bishops. Some local church leaders have invited organizations like the Utah chapter of the National Alliance for the Mentally Ill or Provo's Hope Task Force to make presentations.
The church periodically publishes articles in its magazines about depression, which sometimes include a section on suicide.A 2004 article in the Ensign magazine included a list of suicide warning signs among young people and advised readers to take threats seriously and refer them to appropriate medical or mental health services as necessary.
'Intent and circumstances'
Elder Russell M. Ballard of the Quorum of the Twelve addressed suicide in a 1987 speech during LDS General Conference titled "Suicide: Some Things We Know, and Some Things We Don't."
The talk dealt mostly with LDS doctrine regarding suicide.
"Suicide is a sin a very grievous one, yet the Lord will not judge the person who commits that sin strictly by the act itself. The Lord will look at that person's circumstances and the degree of his accountability at the time of the act," Elder Ballard said.
Furthermore, he said, the full circumstances of every suicide are not known, and God will judge accordingly.
"I feel that the Lord also recognizes differences in intent and circumstances: Was the person who took his life mentally ill? Was he or she so deeply depressed as to be unbalanced or otherwise emotionally disturbed? Was the suicide a tragic, pitiful call for help that went unheeded too long or progressed faster than the victim intended? Did he or she somehow not understand the seriousness of the act? Was he or she suffering from a chemical imbalance that led to despair and a loss of self-control?"
The Catholic view of suicide is much the same as the LDS view.
"We are obliged to accept life gratefully and preserve it for his honor and the salvation of our souls. We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of," according to the Catholic catechism."We should not despair of the eternal salvation of persons who have taken their own lives. By ways known to him alone, God can provide the opportunity for salutary repentance."