Inside a Suicidal Mind

"If I had been better informed of the true risks . . . and if I had read all the things that were in there, I probably would have done something differently," he said.

Crites took the podium last week at a symposium held by Potomac Ridge Behavioral Health, which has a mental health hospital in Rockville. Attending were 100 social workers, psychologists and psychiatrists.

Crites said he told them about Rachel's difficulties surrounding her parents' divorce, her separation from her mother, her father's second divorce and her falling out with her stepmother. He shared some of Rachel's tormented writings.

Rachel had left a note saying she wanted to be buried beside her friend, whom she called her "true love." After all his probing, Crites said he does not think the teens had a romantic relationship, but rather a "nurturing love," which, he said, "I personally don't think . . . contributed to their demise."

At the symposium, Crites talked about how Rachel had been "a cutter," referring to the practice of drawing blood with a razor or knife. Cutters find comfort in physical pain, which is meant in part to blot out emotional pain, experts say.

Especially among teenage girls, cutting is a growing phenomenon.

Goodman, the Rockville social worker, who also talked at the event, said in a later interview that "cutting is clearly an epidemic. . . . It is coming out of the closet in the way that eating disorders came out of the closet in the '80s and '90s."

Adolescents, she said, are at risk for suicide partly because they are often impulsive, "with black and white thinking." When they feel pain, they lack the life experience to know it is transitory.

Any sort of event can be a trigger, she said. "The final thing that happens can be the straw that breaks the camel's back," she said.

For Crites, awareness is one part of a complex picture.

Parents, he said, need to insist on counseling when teens need it. He made the mistake of allowing Rachel to stop group therapy when she asked, he said. "Kids do not get to decide when they need counseling."

Another big issue, he said, is patient privacy rights, which make it hard for caregivers to share information. "Would it have happened differently if we had five people working together instead of five people working independently?" he asked.

Crites still finds it tough to be without the daughter he loved. He went out of town for the anniversary of when she was found: Feb. 2, 2007.

Rachel Smith's family did not return a call seeking comment.

"Two great kids -- not into drugs, not into drinking, wouldn't touch a cigarette," he said. "Great kids. You think they are safe."