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Suicide Intervention

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Intervention
  1. School-based suicide intervention is aimed at identifying, protecting and assisting suicidal students. Source
  2. It is critical that school districts and the schools establish guidelines for identifying, protecting and assisting students who exhibit suicidal or other dangerous behavior. Source
  3. School administrators are encouraged to identify at least one staff member to be an on-site mental health coordinator. This individual could be a school counselor, psychologist, social worker or school nurse. Rural schools may select a teacher. Source
  4. Schools are encouraged to develop a “crisis response plan” outlining procedures for school personnel to follow when working with students exhibiting suicidal behaviors. This plan should be developed by the school administration and should consider input from faculty and staff. Source
  5. School districts are encouraged to create a crisis team that includes local mental health agencies.  When needed, mental health professionals outside the school may assist the school crisis team.  All crisis team members, including professionals from mental health agencies, hospitals, private providers and law enforcement would receive training. Source
  6. School districts should involve the community mental health professionals in all aspects of suicide prevention and intervention procedures. Source
  7. Select a staff member to join the Utah public education crisis team. If schools are unable to free up a staff member for training, the state team may provide training and crisis support for your school.

For more information on joining the state crisis team or for training contact Cathy Bledsoe at cathyb@provo.edu.

Suicide Crisis Indicators

A suicide crisis is a time-limited occurrence in which an individual is in immediate danger of suicide. Indicators of a suicide crisis, sometimes referred to as warning signs, help identify individuals in immediate need of attention.

  • Suicidal statements or suicide notes
  • Ominous utterances (speaking of going away, or of others being better off without them)
  • Marked changes in behavior (e.g., trouble sleeping or eating, loss of interest in usual activities, neglect of self-care)
  • Intense affective state in combination with depression
  • Preoccupation with death, afterlife and violence in the context of sad or negative feelings
  • Precipitating event (e.g., marked reaction to loss of loved one)
  • Statements of hopelessness
  • Deteriorating functioning in school, at work, or socially
  • Telltale actions (e.g., buying a gun, putting one’s affairs in order)
  • Increased use of alcohol or drugs
  • Other self-destructive behavior (e.g., loss of control, rage explosions)
  • Recent incarceration

Source

Research conducted by Dr. Doug Gray found that 60% of adolescents who died by suicide in Utah had been involved with the juvenile court system and/or had truancy concerns.

Protective Factors

Coping Skills and Personal Traits

  • Decision making, anger management, conflict resolution, problem solving and other coping skills
  • A sense of personal control over actions
  • A healthy fear of risky behavior and pain
  • Hope for the future

Connections

  • Religious/spiritual beliefs about the meaning and value of life
  • Positive relationships with family, friends, school, or other caring adults
  • Responsibilities at home or in the community

Health and Home

  • A safe and stable environment
  • Not using drugs and alcohol
  • Access to health care
  • Taking care of self

Source – Maine Youth Suicide Prevention Program

Positive resistance to suicide is not permanent, so programs that support and maintain protection against suicide should be ongoing.

Additional information: http://www.maine.gov

Risk Factors

Include the following:

  • Previous suicide attempts
  • Close family member who has committed suicide
  • Past psychiatric hospitalization
  • Recent losses: This may include the death of a relative, a family divorce, or break up with a girlfriend or boyfriend
  • Social isolation: The individual does not have social alternatives or skills to final alternatives to suicide
  • Drug or alcohol abuse: Drugs decrease impulse control making impulsive suicide more likely. Some individuals try to self-medicate depression with drugs or alcohol
  • Exposure to violence in the home or the social environment: The individual sees violent behavior as a viable solution to life problems
  • Handguns in the home, especially if they are stored loaded

Source – http://www.cdc.gov

Suicidal behaviors are often associated with depression. However, depression by itself is seldom sufficient. Other co-existing disorders, such as attention deficit hyperactivity disorder, substance abuse or anxiety can increase the risk of suicide. Recent stressful events can trigger suicidal behavior, particularly in an impulsive youth. Girls may be more likely to make suicidal attempts, but boys are more likely to make a truly lethal suicide attempt.

Additional information: http://www.afsp.org

Suicide and Bullying

Bullying: Bullying is typically defined as the ongoing physical or emotional victimization of a person by another person or group of people. Cyberbullying is an emerging problem in which people use new communication tehnologies, such as social media and texting, to harass and cause emotional harm to their victims. Bullying increases the risk of suicide.

  • Both victims and perpetrators of bullying are at a higher risk for suicide than their peers
  • Children who are both victims and perpetrators of bullying are at the highest risk
  • Victims of cyberbullying are also at risk for depression. One study found that victims of cyberbullying had higher levels of depression than victims of face-to-face bullying

Research indicates that there are personal characteristics that increase a child’s risk of being bullied. These personal characteristics include the following:

  • Internalizing problems (including withdrawal and anxiety/depression)
  • Low self-esteem
  • Low assertiveness
  • Aggressiveness in early childhood (which can lead to rejection by peers and social isolation)

School based prevention for bullying

  1. Start prevention early. Bullying begins at an age before many of the warning signs of suicide are evident.
  2. Keep up with technology. Bullying often takes place in areas hidden from adult supervision. Cyberspace has become such an area.
  3. Pay special attention to the needs of LGBT youth and young people who do not conform to gender expectations.
  4. Use a comprehensive approach. Reducing the risk of bullying and suicide requires interventions that focus on young people (e.g., mental health services for youth suffering from depression) as well as the environment (especially the school and family environments) in which they live.

Source – http://www.sprc.org/library/Suicide_Bullying_Issue_Brief.pdf

Bullying prevention and suicide prevention share common strategies in three areas: (1) school en­vironment, (2) family outreach, and (3) identification of students in need of mental and behavioral health services (and helping these students and their families find appropriate services).

Talking to Young Children (Ages 4-8)

What to Say and Do

  • Talk with young children about their feelings. Help them label their feelings so they will better understand and be more aware of what is going on inside them. You might ask: “How are you feeling? Are you feeling sad or angry? Do you feel sad or angry only once in awhile or do you feel it a lot of the time?”
  • Encourage young children to express their feelings. Talking to them helps to strengthen the connection between them and you. It also lets them know they can share feelings safely with adults they know. Teach that feelings of hurt and anger can be shared with others who can understand and give support.
  • If a child does not seem to feel comfortable expressing feelings verbally, support other ways to express feelings, such as writing, drawing or being physically active. Give young children healthy ways to express themselves and work through feelings.
  • Explain to young children that being sad from time to time is normal. Sadness is the emotion people feel in times of loss, disappointment or loneliness. Teach children that talking about feeling sad or angry, and even shedding tears or being upset, is OK. Be clear that they should talk to others or do something else when feeling sad, but should not seek to harm themselves in any way.
  • Take steps to ensure that young children do not have easy access to materials they could use to harm themselves. Be certain knives, pills and particularly firearms are inaccessible to all children.
  • Focus on active involvement with young children that provides them with a focus for their feelings and energies. Play games, participate in sports, visit playgrounds and do other activities together. Stay closely connected to them so you can intervene and provide support if necessary.

Source – https://www.dcsdk12.org/cs/groups/public/@webstuhealth/documents/webcontent/dcs1115399.pdf

Unfortunately, even in Utah, students in elementary school attempt suicide. It’s important to remember that younger children express feelings more through actions than words. Play therapy is an excellent resource to use when working with younger children. Be sure to contact your local mental health agency for assistance.

Talking to Young Children (Ages 9-13)

What to Say and Do

  • Be aware of depression and its symptoms in adolescent children. Depression often does not go away on its own and is linked to risk of suicide when it lasts for periods of two weeks or more. Talk with individuals who have knowledge of depression in children to further understand the symptoms and how to intervene.
  • Adolescents have many stressors in their lives and sometimes consider suicide as an escape from their worries or feelings. Be aware of your adolescent’s stressors and talk with him or her about them. Let your child know you care and emphasize that “suicide is not an option; help is always available.” Suicide is a permanent choice.
  • Assist adolescents so they don’t become overwhelmed with negative thoughts, which can lead to thoughts of suicide. Help them learn to manage negative thinking and challenge thoughts of hopelessness. If needed, treatment or therapy can help an adolescent deal with negative thoughts.
  • Emphasize that alcohol and drugs are not a helpful source of escape from the stressors of an adolescent’s life. An adolescent who is suffering from depression and also turns to alcohol and drugs is at a greater risk of attempting suicide.
  • Be attentive to risk factors in an adolescent’s life, as suicide is not always planned at younger ages. Recognizing the warning signs that might be leading to suicide is important.
  • Encourage adolescents to talk about and express their feelings. Provide a listening ear and be a support so they can visit with you about how they feel. Adolescents deal much better with tough circumstances when they have at least one person who believes in them.
Talking to Young Children (Ages 14-18)

What to Say and Do

  • Recognize the signs and symptoms of depression in teens. These may include feelings of sadness, excessive sleep or inability to sleep, weight loss or gain, physical and emotional fatigue, continuing anxiety, social withdrawal from friends or school, misuse of drugs or alcohol and related symptoms. Intervene and get professional help and resources if necessary.
  • Ask teens about what they are feeling, thinking and doing. Open communication helps teens talk freely about their concerns and seek support. Make yourself available to talk with teens often. Avoid being critical or judgmental; listen, don’t immediately “fix” the problem.
  • Provide support if a teen expresses thoughts related to suicide or shares stories of suicide attempts. Stay with him or her and seek additional help. Guide the teen to professional therapists who can give assistance.
  • Listen to teens and pay attention to language related to hurting themselves or others, wanting to “go away” or “just die,” or similar ideas. Such expressions always should be taken seriously. Respond with support for the teen and access resources to provide further counseling or guidance.
  • Encourage teens to be attentive to their peers and quickly report to a respected adult any threats, direct or indirect, that suggest the possibility of suicide. Teens often are aware of such threats among their peers before others and can serve to support peers and provide resources. Talk about the idea that being a true friend means not keeping secrets that could lead to someone being dead.

Source – https://www.dcsdk12.org/cs/groups/public/@webstuhealth/documents/webcontent/dcs1115399.pdf

Bullying may be a concern for students in this age category leading to at-risk behavior and depression. Assessments are helpful to determine the most at-risk students. Peer to peer programs are most successful in preventing bullying and assisting at-risk students.

High Risk Populations

Lesbian, Gay, Bisexual and Transgender Youth

Effective prevention efforts include the following characteristics:

  • Teachers and community leaders are aware of issues for LGBT people such as victimization, difficulties accessing services, and ineffective providers. They also demonstrate awareness of discrimination against transgender people
  • Leaders model appreciation for all youth, condemn any discrimination, and assume an advocacy role for all youth
  • Leaders assess and respect youth’s decision about disclosing to others
  • Promote protective factors such as family support and acceptance, safe schools, caring adults, high self-esteem amongst youth, and positive role models for youth
  • School-family-community partnerships that help promote a safer school environment
  • Viewing LGBT students as a part of, and not separate from, other persons and groups
  • School-climate policies that restrict expressive behavior that might lead to offensive material or interference with the rights of others
  • School communities allowing members to openly discuss the topic in a courteous, respectful, and professional manner
  • The school plays an important role in providing a safe environment for all students.  A safe and non-threatening environment would include zero tolerance of bullying and condemn any and all discrimination.

Source – Suicide Prevention Resource Center

In comparison to the mainstream population, LGBT youth experience higher rates of suicidal thoughts and behavior.  Often alienated from family and school, LGBT youth struggle against stigma and discrimination. Educators must provide a safe non-threatening school environment for all students, ensuring that LGBT youth are not bullied, victimized, or excluded.  Caring adults must take the lead in creating safe places for LGBT youth.

Additional information: http://www.sprc.org

Prevention Resources for LGBT Youth

Suicide Risk and Prevention for LGBT Youth Excellent, extensive resource from the Suicide Prevention Resource Center (www.sprc.org) View pdf here: Suicide Risk and Prevention for LGBT Youth

Preventing Suicidal Behavior among LGBT Youth – Assessment for Your AgencyFrom the Suicide Prevention Resource Center (www.sprc.org) View pdf here: Preventing Suicidal Behavior among LGBT Youth

NAMI Guide/Resources for LGBT Individuals Suffering from Mental Illness View pdf here: A Mental Health Recovery and Community Integration Guide

Suicidal Behavior among LGBT Youth 
From the National Center for the Prevention of Youth Suicide View pdf here: Suicidal Behavior among LGBT Youth

LGBT Knowledge Assessment Tool (basic answers about LGBT)
From the Child Welfare League of America View site here: LGBT Knowledge Assessment Tool Answer Key

The Trevor Project – Preventing Suicide among LGBT Youth
Visit site: www.thetrevorproject.org
Helping Families Support their LGBT Children
View pdf here: Helping Families Support their LGBT Children

Supportive Families, Healthy Children: Helping Families with LGBT Children
View site resources here: Helping Families with LGBT Children
Talking About Suicide and LGBT Populations (recommendations for media)
View pdf here: Talking About Suicide and LGBT Populations

Creating a Safe Space for LGBT Youth – A Toolkit
View site here: Creating a Safe Space for LGBT Youth

Facts About Suicide and Mental Disorders in Adolescents

Suicide is not inexplicable and is not simply the result of stress or difficult life circumstances. The key suicide risk factor is an undiagnosed, untreated, or ineffectively treated mental disorder. Research shows that over 90 percent of people who die by suicide have a mental disorder at the time of their death.

In teens, the mental disorders most closely linked to suicide risk are major depressive disorder, bipolar disorder, generalized anxiety disorder, conduct disorder, substance use disorder, and eating disorders. While in some cases these disorders may be precipitated by environmental stressors, they can also occur as a result of changes in brain chemistry, even in the absence of an identifiable or obvious “reason.”

Suicide is almost always complicated. In addition to the underlying disorders listed above, suicide risk can be affected by personality factors such as impulsivity, aggression, and hopelessness. Moreover, suicide risk can also be exacerbated by stressful life circumstances such as a history of childhood physical and/or sexual abuse; death, divorce, or other trauma in the family; persistent serious family conflict; traumatic breakups of romantic relationships; trouble with the law; school failures and other major disappointments; and bullying, harassment, or victimization by peers.

It is important to remember that the vast majority of teens who experience even very stressful life events do not become suicidal. In some cases, such experiences can be a catalyst for suicidal behavior in teens who are already struggling with depression or other mental health problems. In others, traumatic experiences (such as prolonged bullying) can precipitate depression, anxiety, abuse of alcohol or drugs, or another mental disorder, which can increase suicide risk.

Conversely, existing mental disorders may also lead to stressful life experiences such as family conflict, social isolation, relationship breakups, or school failures, which may exacerbate the underlying illness and in turn increase suicide risk.

Source – http://www.afsp.org/files/Surviving/toolkit.pdf

Teachers and School Personnel

The Role of Teacher and School Personnel

It is not the responsibility of teachers or school personnel to counsel at-risk students.  Teachers and school personnel may refer these students to the appropriate helping resource, as directed by the school’s policy or protocol. Most often, schools instruct teachers to relay concerns about individual students to a counselor, a school nurse or another support person in the school. In some cases, teachers may be encouraged to talk directly to a student’s parent or guardian about changes in behavior that may suggest a problem. Teachers and school personnel are encouraged to obtain a copy of their school’s policy or protocol for referring students in need of mental health services.

Source – http://www.morethansad.org/programmanual.pdf

Teachers and school personnel have day-to-day contact with students and are well positioned to observe students’ behavior and to act when they suspect a student may be at risk of self-harm. Schools need to create a structure of support for teachers and school personnel outlining steps for identifying and assisting at-risk students.

How to Identify Students in Distress and At Risk for Suicide

Any sudden or dramatic change affecting a student’s performance, attendance or behavior should be taken seriously, such as:

  • Lack of interest in usual activities
  • An overall decline in grades
  • Decrease in effort
  • Misconduct in the classroom
  • Unexplained or repeated absence or truancy
  • Excessive tobacco smoking or drinking, or drug (including cannabis) misuse
  • Incidents leading to police involvement and student violence.

Source – http://www.k12.wa.us/safetycenter/YouthSuicide/SuicidePrevention.aspx

These signs help identify students at risk for mental and social distress, which may cause thoughts of suicide and ultimately lead to suicidal behavior. If a teacher or school personnel identifies any of these signs, the school team should be alerted and arrangements made for a thorough evaluation of the student.

National Association of School Psychologists Tips for Teachers

  1. Know the warning signs!
  2. Know the school’s responsibilities. Schools have been held liable in the courts for not warning the parents in a timely fashion or adequately supervising the suicidal student.
  3. Encourage students to confide in you.  Let students know that you are there to help, that you care.  Encourage them to come to you if they or someone they know is considering suicide.
  4. Refer student immediately. Do not “send” a student to the school psychologist or counselor.  Escort the child yourself to a member of the school’s crisis team.  If a team has not been identified, notify the principal, psychologist, counselor, nurse or social worker. (And as soon as possible, request that your school organize a crisis team!)
  5. Join the crisis team. You have valuable information to contribute so that the school crisis team can make an accurate assessment of risk.
  6. Advocate for the child. Sometimes administrators may minimize risk factors and warning signs in a particular student.  Advocate for the child until you are certain the child is safe.

http://www.nasponline.org/resources/crisis_safety/suicidept1_general.aspx

The Role of High School Teachers in Preventing Suicide
From the Suicide Prevention Resource Center (SPRC)

Teachers and School Personnel

National Association of School Psychologists Tips for Parents

  1. Know the warning signs!
  2. Do not be afraid to talk to your child. Talking to your children about suicide will not put thoughts into their head.  In fact, all available evidence indicates that talking to your child lowers the risk of suicide. The message is, “Suicide is not an option, help is available.”
  3. Suicide-proof your home. Make the knives, pills and, above all, the firearms inaccessible.
  4. Utilize school and community resources. This can include your school psychologist, crisis intervention personnel, suicide prevention groups or hotlines, or private mental health professionals.
  5. Take immediate action.  If your child indicates he/she is contemplating suicide, or if your gut instinct tells you they might hurt themselves, get help.  Do not leave your child aloneEven if he denies “meaning it,” stay with him. Reassure him.  Seek professional help. If necessary, drive your child to the hospital’s emergency room to ensure that she is in a safe environment until a psychiatric evaluation can be completed.
  6. Listen to your child’s friends.  They may give hints that they are worried about their friend but be uncomfortable telling you directly. Be open. Ask questions.

http://www.nasponline.org/resources/crisis_safety/suicidept1_general.aspx

A Parent’s Guide to Recognizing and Treating Depression in Your Child
Download pdf: Parent Guide to Recognizing and Treating Depression

Teen Suicide – Facts for Families
From the American Academy of Child and Adolescent Psychiatry (AACAP) View pdf here: Teen Suicide – Facts for Families

The Emotional Impact of a Suicide Attempt on Families 
Prevention and Intervention guide from FBSPC View pdf here: The Emotional Impact of a Suicide Attempt on Families

Understanding When Your Child May Be Suicidal (and How to Help)
View pdf here: Understanding When Your Child May Be Suicidal and Ways to Help

For Parents and Caregivers – Helping a Child in Crisis
From SchoolMentalHealth.org View pdf here: For Parents and Caregivers – Helping a Child in Crisis

Preventing Suicidal Behavior Among Youth in Foster Care
From the National Center for the Prevention of Youth Suicide View pdf here: Preventing Suicidal Behavior Among Youth in Foster Care

Suicide Prevention for Family Members (an extensive guide and sample safety plan)
View pdf here: Suicide Prevention for Family Members

Students

The Role of Teens in Preventing Suicide
From the Suicide Prevention Resource Center (www.sprc.org)
View the pdf here: The Role of Teens in Preventing Suicide

Change Your Mind about Mental Health
A suicide prevention guide for students from the APA Help Center
View the pdf here: Change Your Mind about Mental Health

Best Practices

Best Practices Registry
from the Suicide Prevention Resource Center (SPRC)

Question, Persuade, Refer (QPR) Gatekeeper training for Suicide Prevention from the Suicide Prevention Resource Center (SPRC)

Guide to Engaging the Media in Suicide Prevention
from the Suicide Prevention Resource Center (SPRC)

Training: What Gun Owners Can Do to Prevent Suicide
Presented by Paul Quinnett, Ph.D.

The QPR Institute has partnered with injury prevention experts at Dartmouth and Harvard universities to produce a research-based online training program on what gun dealers, ranger masters, and gun owners can do to prevent suicide.

The training is based on extensive research on the role of firearms in suicidal behavior, and how and why restricting access to firearms by people in emotional crisis can save lives. The training is not anti-gun. Rather, it focuses on what gun dealers and gun owners can do in a “foreground check” — not a “background check” – to prevent inappropriate access to firearms and their misuse.