PREVENTING YOUTH SUICIDE IN SCHOOLS

1. Fort Wayne/South Bend Diocese October 6, 2011 Pokagon State Park Alice Jordan-Miles, BA M.Ed. Assistant Director Kathleen L. O’Connell PhD, RN Director Behavioral Health and Family Studies Institute Indiana University – Purdue University Fort Wayne PREVENTING YOUTH SUICIDE IN SCHOOLS Catholic School Principals In-Service

2. Overview • Behavioral Health and Family Studies Institute • The Problem of Youth Suicide • Who is at Risk • Warning Signs • Protective Factors • Risk Factors • Role of Schools in Preventing Suicide • What YOU can do • Recommendations • Questions • PBS - A Cry For Help

3. Behavioral Health and Family Studies Institute • Provides leadership to northeast Indiana community in concerns related to the Institute • Offers professional training to behavioral health and family service providers • Provides a central source of information related to behavioral health and family studies topics • Encourages high school, college and graduate students, post doctoral fellows and other scientists to pursue careers in behavioral health and family studies fields • Collaborates with other IPFW Centers of Excellence to provide northeastern Indiana human service and government agencies consultation, needs assessment, program planning, and evaluation

4. Institute affiliates & sponsors • Indiana Suicide Prevention Coalition • Indiana Cares Youth Suicide Prevention Project • Allen County Suicide Prevention Council • Allen County Health Disparity Coalition • Northeast Indiana Mental Health Coordinating Council • Northeast Indiana AHEC (Area Health Education Centers) • Suicide Prevention Resource Center (SPRC) • Indiana State: • Division of Mental Health and Addiction • Department of Education • Department of Corrections • Department of Health • Mental Health and Addiction Transformation Workgroup • Commission on Mental Health

5. The Problem of Youth Suicide

6. The Scope of the Problem • Definition of terms: • Suicide –death from injury, including poisoning or suffocation, where there is evidence that the injury was self-inflicted and intended to cause death • Suicide attempt – a potentially self-injurious behavior with a nonfatal outcome, for which there is evidence that the person had the intent to kill himself or herself but was rescued or thwarted, or changed his or her mind after taking initial action • Suicide ideation – self-reported thoughts of engaging in suicide-related behavior Source: Suicide Prevention Resource Center (SPRC)

7. General Facts About Suicide • In 2007, suicide was the 11th leading cause of death in the United State claiming 34,598 lives. • Suicide rates among youth (ages 15-24) have increased more than 200% in the last 50 years. • Suicide rates for the elderly (85+) are highest. • 4 times more men than women kill themselves. • 3 times more women than men attempt suicide. • A suicide occurs EVERY 16 minutes in the U.S.

8. Other Suicide Facts • Girls attempt more often; boys complete suicide more often = difference in method • Most youth suicide attempts are triggered by interpersonal conflicts and are impulsive. • Suicide occurs after school hours generally in teen’s home. • Cutting and bullying have increased - both of which can increase risk.

9. Youth Suicide • 1 in 4 (28.1%) youth felt sad or hopeless everyday for two weeks in past year. • 1 in 11 (9.3%) attempted suicide • 1 in 9 (13.5%) made a suicide plan • 1 in 6 (17.2%) seriously considered attempting suicide. • A youth dies by suicide every 4 ½ days in Indiana. Source: Youth Risk Behavior Survey, 2009

10. Magnitude of the Problem: High Schoolers (2007) 36 High School Suicide Deaths (61 deaths ages 20-24) 23,978 High School Youth Suicide Attempts 52,619 High School Youth Thinking of Suicide Source: Indiana Youth Risk Behavior Survey, 2007 / Indiana Mortality Report, 2007

11. Youth Suicide Attempts • Data for suicide attempts are sparse • Attempts are usually not reported to the Department of Health unless medical attention is necessary • Most hospitals don’t “e-code” their data • 1 in 14 (7.2%) reported actually attempting suicide • Parents are usually not aware of non-fatal attempts unless the attempt caused serious medical consequences • It is estimated that there are 100-200 youth suicide attempts for every completed suicide Sources: Indiana Youth Risk Behavior System Report, 2007; American Association of Suicidology, 2008.

12. Youth Suicide Attempts • Youth account for 28% of suicide attempts seen in Indiana emergency departments (ED) • 63% female • 67.8% were poisoning, 24% cutting/piercing • Boys more likely to use hanging or guns • Youth account for 15% of suicide attempts requiring inpatient care • Cost during 2003-2005: • ED $16.8 million (Youth = $3.7 million) • Inpatient $58 million (Youth = $5.5 million) Source: Indiana State Department of Health, Injury Prevention Program

13. Youth Suicide Attempts • In a typical classroom, 1 boy and 2 girls have attempted suicide. • Latinos attempt suicide more than their white or African American peers. • LGBT youth have higher rates of suicide attempts than do their straight peers. • Youth living with mental illness and juvenile offenders also have higher rates. Sources: National Strategy for Suicide Prevention, 2001; John L McIntosh, Indiana University- South Bend; AAS Youth Suicide Fact Sheet; King (1999; 1997, p. 66); CDC.

14. Youth Suicidal Ideation • 1 in 4 (27.5%) youth felt sad or hopeless everyday for two weeks in past year • Nearly 1 in 9 (11.7%) made a suicide plan • Nearly 1 in 6 (15.8%) seriously considered attempting suicide • 52,619 youth in Indiana seriously considered suicide Source: Indiana Youth Risk Behavior System Report 2007

15. Who is at Risk?

16. All youth are at risk

17. What are Risk Factors? • Risk factors are influences that make it morelikely that individuals will develop a mental health problem. • Risk factors can include biological, psychological, or social factors in the individual, family, or community. • The more risk factors a person has, the more he/she is at risk for suicide and other self-destructive behaviors. Source: National Strategy for Suicide Prevention, 2001

18. Risk Factors • Previous suicide attempts • Depression and/or alcohol or substance abuse • Family history of mental disorders, substance abuse, suicide • Easy access to guns • Exposure to other teenagers who have died by suicide • Lack of social support and sense of isolation • Stigma associated with help-seeking behavior • Hopelessness • Impulsive and/or aggressive tendencies • History of trauma or abuse Source: National Strategy for Suicide Prevention, 2001

19. Protective Factors

20. Protective Factors • Access to effective clinical care for mental, physical and substance abuse disorders • Easy access to a variety of clinical interventions and support for help • Restricted access to highly lethal means of suicide Source: National Strategy for Suicide Prevention, 2007

21. Protective Factors • Strong connections to family and community support • Life skills and resiliency (problem solving, impulse control, conflict resolution and nonviolent handling of disputes • Cultural and religious beliefs that discourage suicide and promote self-preservation, help-seeking behavior, and inter-dependence Source: National Strategy for Suicide Prevention, 2007

22. “…focusing on protective factors such as emotional well-being and connectedness with family and friends was as effective or more effective than trying to reduce risk factors in the prevention of suicide.” Borowsky IW, et al. Suicide attempts among American Indian and Alaska Native youth: risk and protective factors. Archives of Pediatrics and Adolescent Medicine, 1999, 153: 543-547.

23. Warning Signs

24. Warning Signs • Feeling: • Anxious or agitated • Hopeless • Rage, uncontrolled anger, or seeking revenge • Trapped- like there’s no way out

25. Warning Signs • Withdrawing from friends, family and society • Experiencing dramatic mood changes • Talking or writing about death, dying or suicide when these behaviors are out of ordinary for individual

26. Warning Signs • Looking for lethal means: seeking firearms, pills, etc. • Acting reckless or engaging in risky activities • Seeing no purpose for life • Feeling they are a burden to others • Threatening to hurt or kill oneself Source: NAMI, NH, www.naminh.org

27. Warning signs – Acute Crisis • Getting in significant trouble in school, at work or with police • Threat of or actual loss of job or financial assets • Fighting with parents, family or friends • Recent loss of a loved one person through death, move, or break-up • Significant changes in family situation such as divorce or physical, emotional, or sexual abuse

28. Direct and Less Verbal Cues Direct Verbal Cues Less Direct Verbal Cues • I wish I were dead • I’m going to end it all • I’ve decided to kill myself • I believe in suicide • If [such and such] doesn’t happen, I’ll kill myself • You will be better off without me • I’m so tired of it all • What’s the point of living? • Here, take this. I won’t be needing this anymore • Who cares if I’m dead anyway • How do you become an organ donor • Pretty soon you won’t have to worry about me

29. Tips for Asking the Suicide Question • ARE YOU THINKING ABOUT HURTING OR KILLING YOURSELF? • If in doubt, don’t wait, ask the question • If the person is reluctant, be persistent • Talk to the person alone in a private setting • Allow the person to talk freely • Give yourself plenty of time

30. remember • How you ask the question is less important than that you ask it • Research shows that talking about suicide with a teen in a caring manner will NOT “put the idea in their heads” They have already been thinking about it – they need you to get them help so they will not act on those thoughts!

31. Resources & Referrals • Have your resources immediately available • QPR Card, phone numbers, counselor’s name and any other information that might help • National Suicide Prevention Lifeline • 1-800-273-TALK • Mental Health Resource Sheet – Allen County

32. What YOUR School Can Do To Prevent Suicides

33. Why Schools? • Potential to prevent suicide and refer youth to help is great: • Reach the highest number of kids • Level of student-to-student interaction is high • Provides contact with adults who want to help • Building help-seeking skills is part of building healthy youth • Schools already have policies to prevent injury and homicide (the other leading causes of death), why not suicide?

34. Why Schools? • Teachers are inadequately trained on issues surrounding adolescent suicide • Most schools do not have training program in place • Teachers who are most likely to have some or inadequate training still did not feel confident they could identify student at-risk for suicide; only 1 in 10 (9%) felt confident • Training increases educators’ confidence; ability to recognize potentially suicidal student by more than 4 times that of teachers who don’t receive training Youth Suicide Prevention School-Based Guide, 2003

35. Preventing Suicide in Schools Can… • Prevent loss of life • Reveal other school problems such as bullying, substance use that can be addressed • Improve academic achievement

36. Prevention/intervention recommendations • Update school policies and protocols by using Lifeline’s School Policy Checklist • Integrate suicide prevention, intervention and postvention into your schools’ crisis response plan • The State of Maine has best practices guidelines: • http://www.maine.gov/suicide/docs/Guidelines%2010-2009--w%20discl.pdf

37. How to get started First Step • Train student service staff in suicide intervention. • Program: Applied Suicide Intervention Skills Training ASIST is a 2-day evidence-based program that is practice dominated and has a clear, easy to use intervention model. • Nurses, guidance counselors, social workers

38. How to get started Second Step • Have remaining staff trained in suicide prevention so they can recognize suicide warning signs, directly address a student exhibiting warning signs, and then refer them to help. • Program: QPR or safeTALK or Connect. These programs are 2-4 hours in length. • **We recommend that you have 1-2 staff members become Trainers in a suicide prevention program. Your Trainer(s) can train the rest of the staff in your building(s) on your time frame. It is more cost effective and sustainable. • **Note: Free evidence-based on-line training for educators is available through the Society for the Prevention of Teen Suicide (http://spts.pldm.com/)

39. How to get started Third Step • The Crisis Response Team and key staff should have suicide postvention training. The training covers best practices for responding to a suicide, the risk of contagion and strategies for reducing this risk, strategies for promoting healing for survivors, and the roles of school staff in postvention response. Connect is the only postvention training on the market.

40. How to get started Fourth Step • Program for students • Students need to be able to recognize and respond to either their own suicide risk or a friend’s. There are classroom curricula that can be implemented in Health class. • Programs: Lifelines, SOS, Look Listen Link, H.E.L.P

41. Free resources • Free resources (posters, wallet cards, etc) are available with the National Suicide Prevention Lifeline (1-800-273-TALK (8255)): http://www.suicidepreventionlifeline.org/App_Files/Media/PDF/NSPL_Order_Form.pdf • See Indiana Cares website for information on all of these programs (www.indianacares.org) or call or email for more information 260-481-0533, indianacares@ipfw.edu

42. What YOU Can Do

43. YOU Can Prevent Youth Suicide • Educate everyone (including yourself!) on warning signs • Be ready, willing and able to intervene • Encourage gatekeeper training • Know your mental health services and child psychiatrists/psychologists

44. How to Intervene • Ask directly about suicide • Don’t leave person alone • Invite expression or thoughts, however negative and scary • Focus on present, not past or future • Actively listen • Remain calm • Ask about whether they have a suicide plan • Involve others • Get them to someone who can help

45. Things to Consider When Talking to a Student • Do they have a suicide plan and what is the lethality? • Do they have access to means? • How lethal/reversible is their method? • How detailed is their plan? • Have they made final “arrangements”? • Giving away cherished possessions • Is their pain unbearable? Are they desperate? • Are they alone, without resources? • Have the made a previous suicide attempt? • Do they have a mental health history? • Do they have a family history?

46. What You Shouldn’t Do • Don’t be vague • Don’t leave person alone • Don’t imply that their thoughts are silly or unimportant • Don’t make promises, including to keep what you’ve heard a secret • Don’t try to convince them that things are not all that bad • Don’t act alone, involve a professional !

47. Questions? Contact Information: Alice Jordan-Miles 481.4184 (office) 415.0556 (cell) jordana@ipfw.edu

48. Cry For Help • http://www.pbs.org/wnet/cryforhelp/episodes/the-film/watch-the-documentary/1/