2014

Suicide prevention, intervention, and postvention

Young people who talk about suicide never attempt or complete suicide.

Fact: Talking about suicide can be a plea for help and a late sign in the progression toward a suicide attempt.

Attempted or completed suicides happen without warning.

Fact: The survivors of a suicide often say that the intention was hidden, however it is more likely that the intention was not recognized.

A survivor of a suicide attempt is likely to make future attempts.

Fact: Adolescents typically make 8-10 attempts before they actually die by suicide

People who really want to die will find a way, it won’t help to try to stop them.

Fact: Most of the time suicidal people are ambivalent about the decision. They are torn between wanting to die and wanting to live. Most suicidal individuals don't want death, they just want the pain of living to stop.

Suicidal youth cannot help themselves.

Fact: While contemplating suicide, young people may have distorted perception of their actual life situation and what solutions are appropriate for them to take. With support, young people can gain full self-direction and self-management of their lives.

Most suicidal youth seek or ask for help with their problems.

Fact: Evidence shows that they often tell their school peers of their thoughts and plans. Adolescents are more likely to “ask” for help through non-verbal gestures than to express their situation verbally to others.

People who threaten suicide are just seeking attention.

Fact: All suicide attempts must be treated as though the person has the intent to die. It is likely that the person has tried to gain attention and, therefore, this attention is needed.

Not every death is preventable.

Fact: No matter how well intentioned, alert and diligent people’s efforts may be, there is no way of preventing all suicides from occurring.

One should not try to discuss suicide with depressed people, it might give them the idea or upset them enough to put them over the edge.

Fact: Many severely depressed individuals have already considered the option of ending their lives. Discussing suicide openly helps the suicidal person sort through problems, and provides a sense of relief and understanding.

PrevalenceEvery 4 hours in America a child commits

suicide3rd leading cause of death 15-24 year-olds (2nd

for 11-19 year olds)25% of high school students at risk at any

given timeU.S. has highest suicide rate among 26

industrialized nations (double the rate)

Prevalence300% increase since 1950 (youth suicide)Approximately 5,000 annuallyApproximately 100-120 attempts per

completed suicideSuicide rates are gross underestimates (many

reported as accidents)

Doing something places school in less jeopardy than doing nothing

Legal IssuesDistrict did not:

Warn Parents ImmediatelyProvide Adequate Student SupervisionProvide Training to Staff

Issues:ForeseeabilityNegligence

Court Cases:Wyke v. Polk County School Board (11th Cir., 1997)“Are School Psychologists Liable,” 1994Montgomery County, Maryland, 1988

Comprehensive Processes for Suicide and/or Violence Prevention Include:PREVENTIONINTERVENTIONPOSTVENTION

Comprehensive programs are built over years!

It is the policy of the Governing Board that all staff members learn how to recognize students at risk, to identify warning signs of suicide, to take preventive precautions, and to report suicide threats to the appropriate parental and professional authorities.

Administration shall ensure that all staff members have been issued a copy of the District's suicide prevention policy and procedures. All staff members are responsible for knowing and acting upon them.

Part of the strategic plan for Clermont County’s Suicide Coalition

Established in October 2003Funded by the Clermont County Mental

Health and Recovery Board through levy dollars

513-528-SAVE (7283)

Provides supportive services to individuals experiencing mental health crisis

Primary purpose is to provide suicide prevention services to callers

Dedicated to reducing suicide attempts, saving lives, and restoring hope through education, advocacy and collaboration in suicide prevention

Residents of Clermont County of all ages

24 hours a day, 7 days per weekUnique feature – Mobile phone Hotline3 responders – highly qualified

GatekeeperIndividuals who by the nature of their job, their

special interest in people, or in their personal relationships and friendships are in a position to observe high-risk behaviors and warning signs and take action when necessary

Gatekeeping describes the protective functions in the process of using his or her critical skills in recognizing, responding to, and helping suicidal persons get the help they need

The process by which individuals acquire basic suicide prevention and intervention skills

Participants are not intended to be an “expert” at the conclusion

Not intended in any way to replace counseling or mental health services

Intended to offer hope through positive action

Talk about suicideAsk about suicideListenKeep youth safe.Get help.

Recognize risk factors/warning signs

When following-up with the youthEncourage expression of feelingsListen without passing judgmentMake empathic statementsDo not offer reassurances that may not be trueDo not offer simplistic solutions (e.g., “all you

need is a good night’s sleep”)Explore options for support in the environmentGet parents involved with the youth’s

knowledge

Assess lethalityIs the individual making threats? Don’t be

afraid to ask.Does the individual have a plan?How specific is the plan? (e.g., time frame,

details, chance of intervention)Does the individual have access to means that

would assist in carrying out the plan?Has the individual made any previous suicide

attempts?

Collaborate with othersStudentFamily – it is imperative to involve the

PARENT/GUARDIAN!!!!School Personnel (e.g., principal, counselors,

psychologists, mental health workers, and other school professionals)

Community Agencies

Referral for professional helpWhen risk is present (e.g., specific plan,

available means)Know your community resourcesMaintain collaboration with treating agency to

conduct on-going assessment

Risk FactorsVariables that signal the need to look for

warning signs of suicidal thinking.

Warning SignsVariables that signal the possible presence

of suicidal thinking.

Suicide notes Direct & indirect suicide threats Making final arrangements Giving away prized possessions Talking about death Reading, writing, and/or art about death Hopelessness or helplessness Social Withdrawal and isolation Lost involvement in interests & activities Increased risk-taking Heavy use of alcohol or drugs

Abrupt changes in appearanceSudden weight or appetite changeSudden changes in personality or attitudeInability to concentrate/think rationallySudden unexpected happinessSleeplessness or sleepinessIncreased irritability or crying easilyLow self esteem

Dwindling academic performanceAbrupt changes in attendanceFailure to complete assignmentsLack of interest and withdrawalChanged relationshipsDespairing attitude

Postvention= the provision of crisis intervention, support and assistance for those affected by a completed suicide

Primary Goal= Prevent further suicides

Create a Crisis Fact SheetInclude Risk Factors and Warning SignsInclude local sources of assistance

When Suicide is Confirmed:Educate staff about suicide “contagion”Provide suicide postvention

recommendations

Encourage the use of the Clermont County Crisis Response Team

20 years of experience assisting schools and communities in the aftermath of tragedies

70-80 active members comprised of mental health professionals working throughout Clermont County

This could be the most important role for any educator

While remediation of reading and math skills is a worthwhile endeavor, and improving behavioral concerns is certainly helpful, they are not a matter of Life and Death!

Information presented today was the tip of the iceberg; your challenge is to seek out further information, training, and experience!