The SUICIDAL STUDENT: Critical Do

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The SUICIDAL STUDENT Critical Dos and
Donts for Faculty
Brian Van Brunt, Ed.D. Senior Vice President of
Professional Program Development The NCHERM
Group, LLC Brian_at_ncherm.org
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• Vignettes from seasoned faculty that provide
  thoughtful reflections and advice from everyday
  experience
• Research-based suggestions and intervention
  techniques to help faculty better assess,
  intervene, and manage difficult behavior
• Coverage of special populations, including
  nontraditional, veteran, and millennial students
• Discussion of the latest laws and regulations
  that should affect and inform facultys decisions

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Introduction
Warning Signs / What to Do
Case Examples
Training and Outreach
Advice Moving Forward
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Introduction

• Suicidal Students
• Faculty are often put into the difficult position
  of working with students who express suicidal
  ideations or plan to die.
• This program will outline some critical
  approaches to working with these students both in
  and out of the classroom.

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Introduction

• Title II of the Americans with Disabilities Act
  was revised (effective March 15, 2011)
• Applies to public colleges universities
• Likely also extends to private colleges
  universities through OCRs similar interpretation
  of Section 504
• Direct threat means a significant risk to the
  health or safety of others that cannot be
  eliminated by a modification of policies,
  practices or procedures, or by the provision of
  auxiliary aids or services.
• A college or university may take adverse action
  against a student who poses a direct threat.

www.ada.gov/regs2010/titleII_2010/titleII_2010_wit
hbold.htm
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Introduction

• To determine if a direct threat exists, a college
  must make
• An individualized assessment
• Based on reasonable judgment
• That relies on current medical knowledge OR on
  the best available objective evidence, to
  ascertain
• The nature, duration, and severity of the risk
• The probability that the injury will actually
  occur
• Whether reasonable modifications of policies,
  practices, or procedures or the provision of
  auxiliary aids or services will mitigate the risk
  

www.ada.gov/regs2010/titleII_2010/titleII_2010_wit
hbold.htm
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Introduction

• What does this mean?
• As a result of the change in language in Title II
  of the Americans with Disabilities Act (ADA), the
  revised regulation now deems it unlawful to take
  adverse action (e.g. involuntarily separate,
  suspend or expel) towards a student solely on the
  basis of self-harmful or suicidal behaviors.
• This is why most of you are here with us today.

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Introduction

• Additional Resources
• The National Center for Higher Education Risk
  Management (NCHERM) and the National Association
  of Behavioral Intervention Teams (NaBITA) offers
  a free white paper to address this issue.

www.nabita.org/documents/2012NCHERMWHITEPAPERTHEDI
RECTTHREATSTANDARDFINAL_000.pdf
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Introduction

• How might you address a student like this?
• Daria has a history of suicide attempts. Last
  month, she had an overdose of pills leading to a
  3-day inpatient stay.
• She tells her professor that she wont be at the
  exam on Thursday. She will likely be dead.

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Introduction

• How do you feel when students exhibit these
  behaviors?
• Frustrated
• Scared
• Annoyed
• Uncomfortable
• Not bothered at all

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Suicide Myths and Facts
Introduction

• Myth No one can stop a suicide it is inevitable.
• Fact If people in a crisis get the help they
  need, they will probably never be suicidal
  again.
• Myth Confronting a person about suicide will
  only make them angry and increase the risk of
  suicide.
• Fact Asking someone directly about suicide
  lowers anxiety, opens up communication, and
  lowers the risk of an impulsive act.

http//www.qprinstitute.com/
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Suicide Myths and Facts
Introduction

• Myth Only experts can prevent suicide.
• Fact Suicide prevention is everybodys business,
  and anyone can help prevent the tragedy of
  suicide.
• Myth Suicidal people keep their plans to
  themselves.
• Fact Most suicidal people communicate their
  intent sometime during the week preceding
  their attempt.

http//www.qprinstitute.com/
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Suicide Myths and Facts
Introduction

• Myth Those who talk about suicide dont do it.
• Fact People who talk about suicide may try, or
  even complete, an act of self-destruction.
• Myth Once a person decides to complete suicide,
  there is nothing anyone can do to stop them.
• Fact Suicide is the most preventable kind of
  death, and almost any positive action may save
  a life.

http//www.qprinstitute.com/
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Suicide Clues And Warning SignsThe more clues
and signs observed, the greater the risk. Listen
to all signs!
Warning Signs
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Direct Verbal Clues
Warning Signs

• Ive decided to kill myself.
• I wish I were dead.
• Im going to commit suicide.
• Im going to end it all.
• If (such and such) doesnt happen, Ill kill
  myself.

http//www.qprinstitute.com/
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Indirect Verbal Clues
Warning Signs

• Im tired of life. I just cant go on.
• My family would be better off without me.
• Who cares if Im dead anyway.
• I just want out.
• I wont be around much longer.
• Pretty soon you wont have to worry about me.

http//www.qprinstitute.com/
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Behavioral Clues
Warning Signs

• Any previous suicide attempt
• Acquiring a gun or stockpiling pills
• Co-occurring depression, moodiness, hopelessness
• Putting personal affairs in order
• Giving away prized possessions
• Sudden interest or disinterest in religion
• Substance abuse/relapse after a period of
  recovery
• Unexplained anger, aggression and irritability

http//www.qprinstitute.com/
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Situational Clues
Warning Signs

• Being fired or being expelled from school
• A recent unwanted move
• Loss of any major relationship
• Death of a spouse, child, or best friend,
  especially by suicide
• Diagnosis of a serious or terminal illness
• Sudden unexpected loss of freedom/fear of
  punishment
• Anticipated loss of financial security
• Loss of a cherished therapist, counselor or
  teacher
• Fear of becoming a burden to others

http//www.qprinstitute.com/
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Additional Stressors
Warning Signs

• Relationship problems
• Legal problems/substance abuse
• Death within family/friends
• Bullying
• Questions of sexual orientation
• Other suicides
• Loss of function, hope, dreams
• Academic plans, athletic plans, bodily functions

http//www.qprinstitute.com/
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Warning Signs

• Information Leading to Suicide Attempt

• Other Important Indicators
• Presence of mental health disorder
• Mood disorders, anxiety disorders (e.g., PTSD),
  schizophrenia, AOD/addiction issues, eating
  disorders, conduct disorders

• Two Important Indicators
• History of past suicide attempts
• Past or multiple past attempts HIGHER RISK
• Suicidal Ideation Behaviors
• Especially with intent, (specific plans
  preparatory behaviors)

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Warning Signs

• Other Important Indicators

• Psychic pain hurt, anguish, misery
• Perceived burdensomeness
• Stress pressured or overwhelmed
• Agitation emotional urgency
• Hopelessness expectation that things will not
  get better

• Self-hate no self-esteem, self-respect
• Anger, Aggressive tendencies or history of
  violent behavior
• Sleep disturbances
• Intoxication, Recklessness, Impulsivity

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Warning Signs

• Contextual Issues for College Students

• Social Isolation
• Do they have friends
• What are their relationships (if any) like
• Developmental/Intrapersonal Issues
• Exposure to suicidal behavior
• Either within family or through media
• Suicides on Campus students impulsivity

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Warning Signs

• Contextual Issues that Students Bring to Campus

• Victim of Bullying
• History of physical or sexual abuse
• Discrimination related to being lesbian, gay,
  bisexual, transgender
• Medications

• Chaotic family history
• Separation or divorce, change in living situation
  or residence
• History of violence/impulsivity within the family
• Access to, or familiarity with, lethal means
• Mental disorder, drug abuse, suicide
• Culture of firearms in family

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Warning Signs

• Precipitators to Suicide/Triggering Events

• Events leading to shame, humiliation, or despair
• Loss of relationship
• Legal or disciplinary problems
• Interpersonal conflicts
• Failure in class/exams

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Warning Signs

• Those at Highest Risk

• History of suicidal ideation attempts
• Current plan
• Mental health issues (depression, etc.)
• Preparatory acts
• Some triggering event
• High level of impulsivity
• Common among college students
• Lack of appropriate coping skills

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Warning Signs

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Tips for Asking the Suicide Question
What to Do

• If in doubt, dont 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
• Have your resources handy info card, phone
  numbers, counselor

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What to Do

• Remain calm. People often respond to caring,
  kindness and efforts to understand their
  situation. Try not to think that the student is
  personally breaking your rules or trying to ruin
  your day.

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What to Do

• Leave the scene to get help if the person seems
  threatening to you, or if you feel in danger. Do
  not ignore these feelings. While it is best to
  never leave a person in crisis alone, your safety
  always comes first!

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What to Do

• Call for back-up if there is even an elevated
  level of risk. Think of the hot potato game.
  You dont want to be left holding the
  responsibility. It is your job and responsibility
  to report substance abuse, suicidal or violent
  behavior.

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What to Do

• Call campus police immediately when students
  hurt themselves. Rule of thumb if you see blood
  or a weapon, someone needs to call the police.
  Apply first aid within your scope of practice
  (what you have been trained to do).

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What to Do

• Follow up on a situation. If you are not
  face-to-face with the student and come by
  information second hand, dont wait to pass it
  on. Dont wait to pass on information or wait
  until youre one-on-one if the situation needs
  immediate attention.

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What to Do

• Dont worry that your questions or calls are
  going to make the student worse. Often, the
  suicidal student can become frustrated by people
  trying to help.

Remember, the students are responsible for their
actions. You are responsible for passing the
information along.
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Case Examples

• What is a chronically suicidal student like?
• Kevin shares a history of self injury and has
  numerous cuts on his arms, which are visible and
  upsetting to other students. He tells them Im
  always depressed and think of killing myself. I
  dont think Ill do itbut I never really know

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Case Examples
Prochaska and DiClementes Change Theory
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Stage of Change Faculty Members Motivational Task
Pre-contemplation Raise doubt increase their perception of risk and problems with current behavior
Contemplation Help student head towards change out of their current ambivalence help them identify risk for not changing strengthen self-efficacy for changing current behavior
Preparation for Action Help the student identify and select the best initial course of action reinforce movement in this direction
Action Help the student take steps towards change provide encouragement and praise
Maintenance Relapse Teach student relapse prevention skills
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Case Examples

• Can eating disorders be considered suicidal?
• Nancy is taking a full load of courses at your
  community college.
• Nancy has a low BMI, engages in binging/purging
  cycles and over-exercises several times a day for
  6-8 hours.
• She fainted a second time in a bathroom outside
  the classroom.

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1
Be Proactive (create environment, choose
response before problems start)
2
Begin with the End in Mind (create cognitive
mindset, what is the vision, what is the habit)
3
Put First Things First (application of mindset,
habit in action, short-term goals)
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Stephen Covey 7 Habits of Highly Effective
People
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Think Win-Win (achievements depend on
cooperation, working together)
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Understand then be Understood (diagnosis first,
then prescribe)
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Synergize (the whole is greater than the sum of
its parts)
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Sharpen the Saw (maintain and renew)
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Training and Outreach

• What can we do?
• Prevention
• Intervene before there is a problem
• Gatekeeping
• Develop maintain relationships
• Education
• Stop the stigma, support the person

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Training and Outreach

• Educate the campus demystify
• Orientation programming
• Creative speakers to talk about mental illness
• Awareness campaigns
• Train those who see students
• Faculty and administrators
• Office staff
• Coaches and advisors
• Police, parking, and custodial
• Student leaders and resident assistants/advisors

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Training and Outreach

• Additional Resources
• The JED Foundation
• Active Minds www.activeminds.org
• www.facebook.com/BipolarBoy

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Training and Outreach
QPR

• QPR is one approach to educating staff,
• faculty, and students in order to prevent
• suicides on campus.
• This approach is similar to CPR in its focus on
  training those in a short, 90-minute session
  provided to non-clinical staff.
• Question signs/symptoms of suicidal behavior
• Persuade people to get help
• Refer them directly to that help
• QPR training is 495 for 1 day training that
  allows the trainer to offer it on campus.

http//www.qprinstitute.com/
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Training and Outreach

• safeTALK
• safeTALK is suicide alertness for everyone and
  teaches participants how to recognize when
  thoughts of suicide are present how to initiate
  alert steps to get some assistance.
• The TALK steps are Tell, Ask, Listen, and Keep
  Safe. The training includes discussion of why
  persons might miss, dismiss, or avoid the idea of
  suicide and offers participants the opportunity
  to practice TALK steps.
• safeTALK participant cost 6 resource book,
  pocket card, sticker, and certificate. safeTALK
  training for trainers costs 400-600 (cost is
  lower if you have 10 trainer candidates).
  Trainer prerequisite is ASIST training.

www.livingworks.net
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Advice Moving Forward

• Invest in Case Management
• Counseling Center Models
• Administrative Models
• Student Affairs
• Behavioral Intervention Team
• Student Conduct
• Emergency Management
• Provosts Office/Academic Affairs
• Human Resources
• Third party company as a fee-for-service

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Advice Moving Forward

• Understanding Level of Care
• Online support/paraprofessional (RA)/friend
• Consulting evaluation (stop by)
• Outpatient treatment
• Weekly or bi-weekly
• Psychological Testing
• Medication Referrals
• Case Management/Team meeting
• Partial Day Treatment (1x/week)
• Crisis Stabilization Unit
• Inpatient Unit

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Advice Moving Forward

• A single event can have rippling effects
  throughout the community
• Faculty in the classroom
• Residence hall/floor
• Athletic teams
• Clubs and organizations
• Family and parents
• Admissions and university PR
• Students that are already struggling on the edge

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Advice Moving Forward
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Advice Moving Forward

• Involve the student in the conversation
• Consider the individual student and look for
  common goals for the student and the school (e.g.
  graduation, good grades, financial aid
  eligibility)
• Look for ways to minimize or manage disruption,
  rather than referring to the conduct process
• Involve family in a cooperative process build
  alliances

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Advice Moving Forward

• Be flexible and generous with voluntary
  withdrawal and incompletes, if possible
• Assist with office campus referrals get
  everyone at the table once
• Dont lock the door once they leave
• Consistent risk assessment and intervention model
  (including when to refer to conduct/counseling)

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Advice Moving Forward

• Know the limits and the opportunities of FERPA
• Determine who has a legitimate educational
  interest in knowing information
• Value of interdisciplinary teams and approaches
• Empower the person that the student trusts
• Educate faculty and frontline staff
• Talk to parents . . .
• AND to students
• Invite the people you need
• to the table
• Create a culture of reporting

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Dont Do This

• Things to avoid when working with suicidal
  students
• Take an Us vs. Them approach
• See suicidal behavior like drinking violations
• Let FERPA/HIPAA and confidentiality law limit
  your communications unnecessarily
• Adopt a no parents approach
• Let students with mental health conditions off
  the hook when they violate a conduct code
• Coerce students into a voluntary leave by giving
  them few options

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Do This

• Things to do when working with at-risk students
• Dont be afraid of conversations
• Empower and support the faculty and staff with
• whom the student has a relationship
• Involve parents/support early and often
• Assist and support students through medical
  withdrawal options (academics, tuition, support)
• Create clear policies that show care for students

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• Questions?

Brian Van Brunt, Ed.D. Senior Vice President of
Professional Program Development The NCHERM
Group, LLC Brian_at_ncherm.org