Suicide Prevention: A Framework for School Planning

1. Suicide Prevention: A Framework forSchool Planning 2009 Administrators’ Management Meeting for Exceptional Education & Student Services Personnel September 17, 2009 Stephen Roggenbaum University of South Florida Louis de la Parte Florida Mental Health Institute

2. “Breakfast Club”1985 Movie revolves around five teenagers, each from a different clique: John Bender (Judd Nelson) "The Criminal"; Claire Standish (Molly Ringwald) "The Princess"; Brian Johnson (Anthony Michael Hall) "The Brain"; Andy Clark (Emilio Estevez) "The Athlete"; and Allison Reynolds (Ally Sheedy) "The Odd Ball". Suicide prevention programs, activities, and adults in the schools should reach out to the variety of students in our charge.

3. Dear Mr. Vernon, We accept the fact that we had to sacrifice a whole Saturday in detention for whatever it was we did wrong, but we think you're crazy to make us write an essay telling you who we think we are. You see us as you want to see us... In the simplest terms and the most convenient definitions. But what we found out is that each one of us is a brain...Brian Johnson ...and an athlete...Andy Clark ...and an odd ball...Allison Reynolds ...a princess...Claire Standish ...and a criminal...John Bender.Does that answer your question?... Sincerely yours, the Breakfast Club “Breakfast Club”

4. “Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has.” Margaret Mead

5. Truth Or Myth 1. Survivors at lower risk 2. MH professionals only ones who can help 3. More common with the rich 4. No correlation between drugs, alcohol and suicide 5. As many as two youth attempts to every death

6. Truth Or Myth Continued 6. Most suffer from depression 7. More Floridians die by suicide than homicide 8. Most have made up their minds 9. More girls attempt suicide, more boys die by suicide 10. People who are suicidal tend to hide it

7. Truth Or Myth Continued 11. Need to take all talk seriously 12. Suicide rates for 15-24 year olds have more than doubled since the 1950s while other rates stayed about the same 13. Asking about suicide may encourage the idea 14. Elderly have the highest rate 15. Important not to break the trust of confidentiality

8. 2006 National Statistics • 3,300 suicides (91.2 per day) • Firearms used in more than half of all suicides (50.7%) • 3.8 male deaths by suicide for each female death • Suicide claims a life every 15.8 minutes Source: AAS, USA Suicide: 2005 Official Final Data

9. In 2007, there were 2,570 suicides in Florida

10. 2007 Florida Statistics Over 2,000 deaths (2,570 = 7 a day) 3rd leading cause for 15-24 yr olds 3.4 male deaths by suicide for each female death Suicide rate nearly 2 x homicide rate Source: DOH, Florida 2007 Vital Statistics Report

11. 2007 High Schoolers Report… Youth risk behavior surveillance, CDC 2008

12. Suicide Deaths: 15-19 year olds CDC / NCIPC / WISQARS

13. Suicide Deaths: 20-24 year olds CDC / NCIPC / WISQARS

14. “I thought about it and not just once. But I was lucky there was someone there who helped me see that it was not the best solution or the only solution.” Chrissie age 16 Youth Suicide Prevention Study, USF Prevention is often a matter of a caring person with the right knowledge being available in the right place at the right time.

15. Risk Factors • Psychopathology • Mood disorders (major depressive disorder, dysthymic disorder, bipolar disorder) • Substance-related disorders • Disruptive behavior disorders • Previous Suicide Attempt • Social isolation • Limited access to mental health facilities • Poor problem-solving and coping skills • Problematic parenting or family environments • Access to lethal weapons • Repeated engagement in or exposure to violence • Cultural or religious beliefs Miller, DN, & Eckert, TL (2009).

16. Risk Factors Continued • Under or untreated (e.g., for suicidal ideation) • Minority youth (racial/ethnic and sexual minority) • Exposure to suicide of peer Miller, DN, & Eckert, TL (2009). Youth Suicidal Behavior: An introduction and Overview

17. Depression and Suicide Depression often goes undiagnosed until a crisis occurs Be concerned if significant changes are noted, symptoms last 2 weeks or longer Change in eating/sleeping, isolating, difficulty making decisions, feelings of hopelessness, irritability, anger, vague physical complaints NAMI, What Families Should Know about Adolescent Depression and Treatment Options, May 2005

18. Warning Signs • Rage, anger, seeking revenge • Acting reckless or engaging in risky activities • Feeling trapped • Increasing alcohol or drug use • Withdrawing from friends, family, or society • Experiencing anxiety and/or agitation • Unable to sleep or sleeping excessively • Dramatic mood changes • Perceiving no reason for living / no sense of purpose in life Miller, DN, & Eckert, TL (2009). Youth Suicidal Behavior: An introduction and Overview

19. Warning Signs Continued • Under or untreated (e.g., for suicidal ideation) • Minority youth (racial/ethnic and sexual minority) • Exposure to suicide of peer Miller, DN, & Eckert, TL (2009). Youth Suicidal Behavior: An introduction and Overview

20. Youth Protective Factors • Positive connections to school • Coping and problem solving skills • Academic achievement • Family cohesion/stability • Help-seeking behaviors • Good relationships with other youth • Positive self worth and impulse control • Access to care for mental/physical/ substance disorders

21. A Scientific Approach to Suicide Prevention Identify the causes Assess the problem Implement programs Identify and test interventions

22. Suicide Prevention Indicated Youth identified as at risk Selected Youth in at-risk groups All Youth in School Universal

23. Planning Tools • Youth Suicide Prevention School-based Guide http://theguide.fmhi.usf.edu • Wisconsin MHA’s School-Based Modelhttp://www.mhawisconsin.org/content/schoolbasedmodel.asp • SPRC/AFSP Best Practice Registry http://www.sprc.org/featured_resources/bpr/index.asp • Maine’s Youth Suicide Prevention Program http://www.maine.gov/suicide/

24. The Youth Suicide Prevention School-based Guide • Developed by The Louis de la Parte Florida Mental Health Institute • Funded by the Institute for Child Health Policy at Nova Southeastern University • Funding source was a Florida Drug Free Communities Program Award

25. GUIDE CONTENTS • Overview • Issue Briefs • Checklists • School Based Suicide Prevention Programs • Resources and Links • American Association of Suicidology Statistics Also Available: • Annotated Bibliography • Literature Review

26. LinkedInformation Issue Briefs Information content The Guide’sthree levels of use: Checklists school self-assessment References research citations forfurther exploration

27. The 9 Categories (Issue Briefs) • Information Dissemination • School Climate • Risk factors, Protective Factors, & Warning Signs • Administrative Issues • Prevention Strategies

28. The 9 Categories (Issue Briefs) continued • Intervention Strategies • Postvention Strategies (Media Guidelines) • Family Partnerships • Culturally & Linguistically Diverse Groups

29. Guide Checklists Please take a few minutes and complete checklist 1 and checklist 2. When you are finished, share and compare your responses with others from your same school or school district.

30. Best Practice Registryhttp://www.sprc.org/featured_resources/bpr/index.asp

31. Best Practice Registryhttp://www.sprc.org/featured_resources/bpr/ebpp.asp

32. Best Practice Registryhttp://www.sprc.org/featured_resources/bpr/nrepp_bpr.asp

33. Best Practice Registryhttp://www.sprc.org/featured_resources/bpr/expert.asp

34. Best Practice Registryhttp://www.sprc.org/featured_resources/bpr/standards.asp

35. Conclusion Preventing suicide is like the many fragments of a puzzle. We need to work together – until the pieces of the puzzle come together. “We cannot change the past, but together we can shape a different future.” David Satcher, Former US Surgeon General

36. The Youth Suicide Prevention School-based Guide is available FREE online at http://theguide.fmhi.usf.edu For more information contact Stephen Roggenbaum roggenba@fmhi.usf.edu 813-974-6149

37. What Will You Do? “It is not enough to be compassionate. You must act.” Dalai Lama "The Path to Tranquility: Daily Wisdom”