Suicide Prevention, Intervention, and Postvention for Educators

1. Suicide Prevention, Intervention, and Postvention for Educators Southeast Nebraska Suicide Prevention Project and Robin Zagurski, LCSW University of Nebraska Medical Center Supported by a grant from the Nebraska Healthcare Cash Fund

2. Objectives for Educators • Know symptoms of depression in adolescents • Understand that suicide is a public health problem • Identify ways to protect yourself and others from suicide • Identify suicide risk factors • Know the red light warning signs for suicide risk • Are comfortable offering help to someone at risk for suicide • Have resources for postvention after a student suicide

3. Common terms used in this presentation • Suicide – Intentionally taking one’s own life • Suicide act or gesture – Actions to deliberately injure oneself or attempt to injure oneself without resulting in death. • Suicide Behavior – Thoughts, plans, or actions which if implemented could result in death • Postvention - An intervention after a suicide for the students, faculty and friends designed to facilitate grieving.

4. Questions Concerns Worries Beliefs

5. Teen Depression Teenagers, especially young teens, may exhibit several symptoms of depression and yet be unaware that they are suffering from depression.

6. Adolescent Depression • Extreme sensitivity to rejection or failure • Low self-esteem and feelings of guilt • Frequent complaints of physical illnesses such as headaches and stomachaches • Frequent absences from school or poor performance in school • Threats or attempts to run away from home • Major changes in eating or sleeping patterns (American Academy of Child and Adolescent Psychiatry, 8/98)

7. Adolescent Depression • Sad, blue, irritable and/or complains that nothing is fun anymore • Trouble sleeping, low energy, poor appetite and trouble concentrating • Socially withdrawn or performs more poorly in school • Can be suicidal National Institute of Mental Health, Treatment of Adolescent Depression Study (TADS)

8. Adolescent Anxiety • Excessive worries • Worries about school performance • Difficulty making friends • Isolative • Perfectionistic • Rigid thinking and behavior patterns • Phobias

9. Suicidal Ideation(Hoberman and Garfinkel 1988) In a study of 229 completed youth suicides: • 62% had made a suicidal statement • 45% had consumed alcohol within 12 hours of killing themselves • 76% had shown a decline in academic performance in the past year

10. Teen Suicide in the U.S. • There are 25 suicide attempts for every completion for our country as a whole • There are between 100-200 teen attempts before completing suicide • Girls attempt more often (3:1) • Boys complete suicide more often (4:1) • Every year approximately 2,000 teens suicide Journal of American Academy of Child and Adolescent Psychiatry, Practice Parameters, 2002

11. Although suicide is the 11th leading cause of death for the overall population, it is the 3rd leading cause of death for 15-24 year olds.

12. Nebraska Teen Suicide Statistics2001 In Nebraska: • 2 children between the ages of 10-14 killed themselves • 17 teens between the ages of 15-19 killed themselves • 13 of those suicides were by gunshot

13. Cultural Factors • African Americans currently have a lower rate of suicide than whites, • The suicide rate of African-American adolescent and young adult males has been rising rapidly. • Native American and Alaskan Native youth have a very high rate of suicide. • Attempted suicide rates of Hispanic youth are greater than those of white and African-American youth. Journal of American Academy of Child and Adolescent Psychiatry, Practice Parameters, 2002

14. Gay and Lesbian Youth • There is no evidence gay or lesbian youth commit suicide more often than heterosexual teens. • However, there is strong evidence that gay, lesbian and bisexual youths of both sexes are more likely to experience suicidal ideation and attempt suicide.

15. Alcohol and Suicide • Alcoholics have a suicide rate 50 times higher than the general population • Alcohol dependent persons make up 25% of all suicides • 18% of alcoholics eventually complete suicide • States with the most restrictive policies toward alcohol have the lowest suicide rates (Lester, 1993)

16. Self-Injury vs. Suicide Self-injury is an attempt to alter one’s mood by inflicting physical harm on oneself: • Carving • Burning • Scratching • Branding • Hitting

17. Protection Against SuicideGreen Light…Good to Go! • Getting help for mental, physical and substance abuse disorders - Especially depression • Restricted access to highly lethal methods of suicide – especially firearms • An established relationship with a doctor, clergy, teacher, counselor or other professional who can help • Connectedness to community, family, friends • Learned skills in problem solving and non-violent conflict resolution • Cultural/religious beliefs that discourage suicide

18. Suicide Risk FactorsYellow Light – Proceed with Caution • Mental disorders-particularly mood or eating disorders • Substance abuse disorders • Family history of suicide • Hopelessness • Impulsive and /or aggressive tendencies • Barriers to accessing mental health treatment • Divorced parents or poor family communication

19. Suicide Risk FactorsYellow Light – Proceed with Caution • Relational, social, work, or financial loss • Physical illness • Previous suicide act • Easy access to lethal methods, especially guns • Age, Culture, Lack of connectedness • Exposure to sensational media reports of suicide

20. Suicide Warning SignsRed Light – Stop – Get Help • Talking, reading, or writing about suicide/death. • Talking about feeling worthless or helpless. • Saying “I’m going to kill myself,” “I wish I was dead,” or “I shouldn’t have been born.” • Visiting or calling people to say goodbye. • Giving things away or returning borrowed items. • Self destructive or reckless behavior. • Significant change in behavior • Running away

21. Suicide Warning SignsRed Light – Stop – Get Help • Hopelessness – typical hopeless statements: • “There’s no point in going on” • “I can’t take it anymore” • “I have nothing left to live for” • “I can’t stop the pain” • “I can’t live without _______” • “My life keeps getting worse and worse” • “I might as well kill myself”

22. Why should Schools be Involved? • Children come into contact with more potential rescuers in the schools than in the community • Children’s problems are often more apparent in the school than in the home • Children from divorced and/or dysfunctional families are less likely to get help at home Guetzloe, 1991

23. School Specific Signs of Distress Any sudden or dramatic change should be taken seriously, such as: • An overall decline in grades • Decrease in effort • Misconduct in the classroom • Unexplained or repeated absence or truancy

24. Who Should Intervene? Not everyone who works with teenagers should work with a suicidal teenager. • Know your limitations • Get someone else to help if you: • Are a recent suicide survivor • Are experiencing suicidal thoughts yourself • Are experiencing significant stress in your own life • If you have negative personal feelings about the teen

25. What do Educators Need to Know? • There is no confidentiality when a child is talking about suicide • Act immediately. Do not wait until class is over or until the end of the day. • Take action even if you are not sure http://www.nea.org/neatoday/0004/health.html

26. What action? • Immediately contact the school counselor/social worker or school administrator • The school counselor/social worker or school administrator will then contact the student’s parents or guardian • Keep the student under supervision at all times until someone else takes over.

27. What Can YOU Say? • I’m glad you told me, I want to help. • I’m glad you told me, and I am going to find someone to help you. • I will stay with you until help arrives.

28. What NOT to Say… • “It’s just a phase” • “You’ll snap out of it” • “Stop being so selfish” • “You’re just trying to get attention” • “Get over it”

29. What NOT to do…. • Don’t let them bargain you out of getting them help. • Be careful with no-suicide contracts • Don’t make coercive statements, such as “unless you promise not to hurt yourself, you’ll have to go to the hospital”

30. Postvention after a Suicide Goals: • Return the school to its pre-crisis milieu • Identify, refer, and/or assist students who may be at risk for depression, suicide, and other psychological problems due to their exposure and relationship to the victim • Help students begin a healthy grieving process Kerr, Brent and McKain, 1997

31. Guidelines for postvention with students • Explain that it is normal to feel emotions such as shock, fear, sadness, guilt or anger. • Let students know there is no “right way” to feel after a suicide. • Help to clarify facts about the suicide. Ask students to tell you what they have heard. Correct errors and rumors if necessary.

32. Postvention Guidelines (cont) • Stress that no one is to blame for the suicide. The victim alone made the decision to commit suicide. • Focus on recovery of the survivors and alternate methods of dealing with problems. • Rehearse possible condolence messages to the family. Kerr, Brent, McKain 1997

33. Postvention • Emphasize that help is available to all students, not just to those students who are feeling suicidal. • Make sure students know where to go to get help for themselves or for a friend who is depressed or suicidal. Kerr, Brent, McKain 1997

34. What NOT to do after a suicide: • Do not put in a permanent memorial for the person who killed themselves. (i.e., no tree planting, plaques, etc.) • Do not glorify the death by having large memorial services with lots of fanfare.

35. The Southeast Nebraska Suicide Prevention Project Lead Agency: • Blue Valley Mental Health Center Project Partners: • Bryan/LGH Medical Center • Community Mental Health Center of Lancaster County

36. Resources • The Yellow Ribbon Program www.yellowribbon.org • The National Suicide Hopeline 1-800-SUICIDE • BryanLGH Counseling Center 481-5991 • BryanLGH 24-hour Mental Health Assistance Nurse 475-1011 OR 1-800-742-7845 • AFSP Teen Suicide Prevention Kit 1-888-333-AFSP • American Association of Suicidology www.suicidology.org

37. Postvention Guideline Resources • Services for Teens at Risk (STAR): http://www.wpic.pitt.edu/research/star/default.htm Postvention Standards Guidelines: A guide for a school’s response in the aftermath of a sudden death. Kerr, Mary Margaret, Ed.D., Brent, David A., M.D., McKain, Brian, M.S.N.. Star Center Publications, 3rd Edition.

38. School Curriculum Caveat According to the American Academy of Child Psychiatry: • Teaching entire courses on suicide to groups of students should be discouraged as it appears to activate suicidal ideation in disturbed adolescents. • Courses on teaching problem solving, social skills, conflict resolution, and reporting skills are helpful in preventing suicide in teens.

39. School Curriculum Suggestions The National Education Association suggests: • Don’t sensationalize or normalize suicide • General education programs that teach the facts, warning signs, and risk factors associated with suicide do impart knowledge. • Treat suicide prevention within a broader mental health focus—including work on enhancing coping skills and dealing with risk factor issues like substance abuse.

40. Steps parents can take • Get your child help (medical or mental health professional) • Support your child (listen, avoid undue criticism, remain connected) • Become informed (library, local support group, Internet) • Restrict access to firearms Carol Watkins, M.D.

41. Steps teens can take • Take your friend’s actions seriously • Encourage your friend to seek professional help, accompany if necessary • Talk to an adult you trust. Don’t be alone in helping your friend.Carol Watkins, M.D. 4.Don’t keep the secret.