Suicide Prevention, Intervention, and Postvention for Educators

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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
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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

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Common terms used in this presentation

• Suicide Intentionally taking ones 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.

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Questions
Concerns
Worries
Beliefs
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Teen Depression

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

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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)

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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• Socially withdrawn or performs more poorly in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)

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Adolescent Anxiety

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

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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

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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 (31)
• Boys complete suicide more often (41)
• Every year approximately 2,000 teens suicide
• Journal of American Academy of Child and
  Adolescent Psychiatry, Practice Parameters, 2002

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• 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.

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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

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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

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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.

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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)

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Self-Injury vs. Suicide

• Self-injury is an attempt to alter ones mood by
  inflicting physical harm on oneself
• Carving
• Burning
• Scratching
• Branding
• Hitting

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Protection Against SuicideGreen LightGood 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

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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

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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

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Suicide Warning SignsRed Light Stop Get Help

• Talking, reading, or writing about suicide/death.
• Talking about feeling worthless or helpless.
• Saying Im going to kill myself, I wish I was
  dead, or I shouldnt 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

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Suicide Warning SignsRed Light Stop Get Help

• Hopelessness typical hopeless statements
• Theres no point in going on
• I cant take it anymore
• I have nothing left to live for
• I cant stop the pain
• I cant live without _______
• My life keeps getting worse and worse
• I might as well kill myself

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Why should Schools be Involved?

• Children come into contact with more potential
  rescuers in the schools than in the community
• Childrens 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

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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

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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

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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

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What action?

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

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What Can YOU Say?

• Im glad you told me, I want to help.
• Im glad you told me, and I am going to find
  someone to help you.
• I will stay with you until help arrives.

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What NOT to Say

• Its just a phase
• Youll snap out of it
• Stop being so selfish
• Youre just trying to get attention
• Get over it

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What NOT to do.

• Dont let them bargain you out of getting them
  help.
• Be careful with no-suicide contracts
• Dont make coercive statements, such as unless
  you promise not to hurt yourself, youll have to
  go to the hospital

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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

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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.

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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

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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

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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.

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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

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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

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Postvention Guideline Resources

• Services for Teens at Risk (STAR)
• http//www.wpic.pitt.edu/research/star/default.ht
  m
• Postvention Standards Guidelines A guide for a
  schools 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.

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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.

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School Curriculum Suggestions

• The National Education Association suggests
• Dont 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 focusincluding work on enhancing coping
  skills and dealing with risk factor issues like
  substance abuse.

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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.

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Steps teens can take

• Take your friends actions seriously
• Encourage your friend to seek professional help,
  accompany if necessary
• Talk to an adult you trust. Dont be alone in
  helping your friend. Carol Watkins, M.D.
• 4. Dont keep the secret.