“Treating and Preventing Suicidal Behavior”

1. “Treating and Preventing Suicidal Behavior” • Presented by • Peggy G. Kubert, MA, LCSW • Executive Director of Erika’s Lighthouse: • A Beacon of Hope for Adolescent Depression • October 1, 2012

2. Depression is common. It is a serious illness. It’s treatable. There is always help and hope. “You deserve to feelbetter.” Our Guiding Messages You are not alone.

3. Why is Teen Depression Important? • As many as 20% of teens will have at least one depressive episode before adulthood • Two-thirds will go undiagnosed and untreated either out of failure to recognize the symptoms or because of shame • Untreated depression is responsible for more suicide deaths than any other single risk factor • 90% of teens who die by suicide have some form of mental illness. • SAMSA, 2009 • NAMI, 2003 • Institute of Medicine, 2002

4. Top Ten Causes of Death in Youth Ages 11 – 24(Center for Disease Control, 2004)

5. Illness Related Cause of Death in Youth Ages 11 – 24(Center for Disease Control, 2004)

6. SuicideWarningSigns • Observable signs of outward depression • Increased risk taking behavior Increase in alcohol & drug use Impulsiveness Risky sexual behavior • Threatening suicide or expressing wishes to die • Definitive plan • Increased rage and anger

7. Risk Factors: Static & Social/Environmental • Family history of suicide or suicide attempts • Parental mental health problems • LGBTQ and questioning teens • History of physical or sexual abuse • Previous suicide attempt • Access to firearms or other lethal means • Impaired parent-child relationship • Difficulties in school, falling grades, not attending school, bullying • Social isolation – feeling like you don’t belong anywhere • Stressful life events (legal, break-ups, family problems, death of a loved one) • Recent suicides/attempts in school or social group Harris, Br J Psychiarty.1997; Shain. Pediatrics. 2007;120:669-676

8. Risk Factors: Psychiatric • Most common psychiatric risk factor resulting in suicide: • Depression* • Major Depression • Bipolar Depression • Alcohol & DrugAbuse • Schizophrenia • Other psychiatric risk factors • Post Traumatic Stress Disorder (PTSD) • Eating disorders • Non-Suicidal Self-Injury Harris, Br J Psychiarty.1997; Shain. Pediatrics. 2007;120:669-676

9. What is depression? A disorder of the brain that affects our thoughts, moods and behaviors • Must have at least FIVE symptoms for most of every day • for two weeks or more • Sad, depressed or irritable mood • Little or no interest in pleasurable or favorite activities Significant weight loss, weight gain or change in appetite Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue Feelings of worthlessness; excessive or inappropriate guilt Diminished ability to think or concentrate; indecisiveness Recurrent thoughts of death, suicidal ideation, suicide attempt or plan

10. Signs in School Sad, depressed or irritable mood Loss of interest in favorite activities Significant weight loss or gain Restlessness, agitation or anxiety Fatigue or loss of energy, including sleeping in class Feelings of guilt Low self-esteem Trouble concentrating or making decisions Repeated thoughts of death or suicide, expressed verbally or in writing Frequent headaches and stomach-aches Cutting or other self-injury Extreme aggressiveness Inattention to appearance Excessive risk-taking behavior Drop in school performance Low tolerance for frustration Lack of motivation, apathy Disrespect Social withdrawal Misbehavior Unable to store or retrieve information Forgotten materials/assignments Frequent absences, trips to school nurse Crying in class

11. When talking with students… Never promise to keep a secret - discuss limits of confidentiality. Ask general questions: “how have you been doing?” “what kind of things have been stressing you out lately?” “How have things been going with (school, friends, parents, sports?)” Follow-up with more detailed questions.

12. Questions for students… If concerned about depression: “Everyone feels sad, angry, stressed or irritable at times. How about you?” If concerned about suicide: “Have you ever thought about killing yourself or wished you were dead?” “Have you ever done anything on purpose to hurt or kill yourself” Jason J. Washburn, Ph.D., ABPP-CC, Director, Center for Evidence-Based Practice Remember, this is an illness —no blame, no shame

13. If he said “NO” – now what? • Be honest and compassionate.“You deserve to feel better and we will help you at any time.” • Encourage discussion. • Keep the door open for future conversations.

14. If she said YES – now what? • Remain calm and acknowledge the deep despair – “sounds like things have been really difficult.” • Provide reassurance that you have heard them and you will help. • Keep the student with you at all times- Do not wait, act immediately, and follow your school protocol. If need be, call security. • Notify parents or guardian immediately and arrange crisis care which may include going to the hospital for a psychological evaluation.

15. Involving Parents Encourage parents to talk to the child’s pediatrician to rule out another illness. Get a mental health assessment for an accurate diagnosis. Offer recommendations for a therapist that fits the child’s needs and personality. May need talk therapy, medication management, or both. Facilitate communication between parents and other adults, therapists and the school. Educate and assist parents to manage their fears and anxiety.

16. What Can Schools Do? • Have a protocol to establish a culture of mental health in the school and to get students the help they need if they are suffering from depression or another mental illness • Establish a mental health task force and determine what is currently in place to address mental illness and mental health • Train faculty to recognize signs of depression and suicide & make appropriate referrals • Develop a protocol to address the concerns of the faculty or staff about a student • Develop a protocol for taking immediate action if a student is in danger of taking her or her life, self – injury or injury to others

17. What more can schools do? • Teach mental health curriculum and promote social and emotional well being • Set up supportive environment that models good mental health - evaluate stress factor in school • Build in accommodations and flexibility • Provide a safe haven for respite • Encourage continuous communication and collaboration • Establish a “student voice” which will encourage students to be respectful and aware of stigma around mental illness

18. Erika’s Lighthouse Programs and Materials For Schools: • The Red Flags Program, depression education for 5th- 8th grades • Real Teenagers Talking About Adolescent Depression: A Video-Based Study Guide For Teens: • Helping high school students start and run an Erika’s Lighthouse Club at their school • Training teens to present educational Teen Panels and share stories about depression to younger students and peers For Parents: • A video and Parent Handbook on Childhood and Adolescent Depression, how to get help and what parents need to know about depression and treatment For Everyone: • An annual Walkathon to raise awareness and to “get depression out of the dark” • School, parent and professional workshops on depression awareness and suicide prevention • Our website: erikaslighthouse.org

19. Red Flags/Claire’s Storyfor Middle School Video based curriculum Diagnosis and symptoms of depression Treatment plans Living with depression www.redflags.org We provide the training and materials for this curriculum to teachers, support staff, and parents at no cost to schools

20. Our study guide Based on our video, Real Teenagers Talking about Adolescent Depression Brief exercises to deepen teens’ understanding of depression Exercises on the science of the brain and depression, the stigma surrounding depression and bullying and depression Exercises on coping with stress and building resiliency and how to help a friend who is suffering from depression Suggested Mental Health Protocols for Schools Online Resources for Mental Health, Stigma, Coping & Bullying • Order at • erikaslighthouse.org

21. Takeaway • Bookmark includes: • the signs and symptoms of depression • tips on how to help yourself • tips on how to help a friend • space to write the name of a trusted friend you can talk to

22. What A Difference A Friend Makes • Be understanding and supportive. • Let them know they’re not alone. • Know there’s a limit to what you can do. Encourage talking to an adult who can help. • Have patience. Don’t expect them to just “snap out of it”. • Don’t enable isolation, even when being pushed away. Being present can make a huge impact. • Stay positive. • Emphasize the fact that depression is a treatable condition and to go get help.

23. Suggestionsfor self care:You can’t be available to your students if you don’t take care of yourself. Maintain a healthy lifestyle Practice stress management Set Boundaries Have Fun

24. Good Mental Health: our ultimate goal. What does good mental health look like? 1. Strong meaningful relationships 2. A purpose to one’s life 3. Setting and achieving goals towards that purpose

25. Get Depression Out of the Dark www.erikaslighthouse.org