PREVENTING YOUTH SUICIDE IN SCHOOLS

Catholic School Principals In-Service

Fort Wayne/South Bend Diocese

October 6, 2011Pokagon State Park

Alice Jordan-Miles, BA M.Ed.Assistant Director

Kathleen L. O’Connell PhD, RNDirector

Behavioral Health and Family Studies Institute Indiana University – Purdue University Fort Wayne

OVERVIEW Behavioral Health and

Family Studies Institute The Problem of Youth

Suicide Who is at Risk Warning Signs Protective Factors

Risk Factors Role of Schools in

Preventing Suicide What YOU can do Recommendations Questions PBS - A Cry For Help

BEHAVIORAL HEALTH AND FAMILY STUDIES INSTITUTE

Provides leadership to northeast Indiana community in concerns related to the Institute

Offers professional training to behavioral health and family service providers

Provides a central source of information related to behavioral health and family studies topics

Encourages high school, college and graduate students, post doctoral fellows and other scientists to pursue careers in behavioral health and family studies fields

Collaborates with other IPFW Centers of Excellence to provide northeastern Indiana human service and government agencies consultation, needs assessment, program planning, and evaluation

INSTITUTE AFFILIATES & SPONSORS Indiana Suicide Prevention

Coalition Indiana Cares Youth Suicide

Prevention Project Allen County Suicide

Prevention Council Allen County Health

Disparity Coalition Northeast Indiana Mental

Health Coordinating Council Northeast Indiana AHEC

(Area Health Education Centers)

Suicide Prevention Resource Center (SPRC)

Indiana State: Division of Mental

Health and Addiction Department of

Education Department of

Corrections Department of Health Mental Health and

Addiction Transformation Workgroup

Commission on Mental Health

The Problem of Youth Suicide

THE SCOPE OF THE PROBLEM Definition of terms:

Suicide – death from injury, including poisoning or suffocation, where there is evidence that the injury was self-inflicted and intended to cause death

Suicide attempt – a potentially self-injurious behavior with a nonfatal outcome, for which there is evidence that the person had the intent to kill himself or herself but was rescued or thwarted, or changed his or her mind after taking initial action

Suicide ideation – self-reported thoughts of engaging in suicide-related behavior

Source: Suicide Prevention Resource Center (SPRC)

GENERAL FACTS ABOUT SUICIDE In 2007, suicide was the 11th leading cause of

death in the United State claiming 34,598 lives. Suicide rates among youth (ages 15-24) have

increased more than 200% in the last 50 years. Suicide rates for the elderly (85+) are highest. 4 times more men than women kill

themselves. 3 times more women than men attempt

suicide. A suicide occurs EVERY 16 minutes in the

U.S.

OTHER SUICIDE FACTS Girls attempt more often; boys complete

suicide more often = difference in method Most youth suicide attempts are triggered by

interpersonal conflicts and are impulsive. Suicide occurs after school hours generally in

teen’s home. Cutting and bullying have increased - both of

which can increase risk.

YOUTH SUICIDE1 in 4 (28.1%) youth felt sad or hopeless

everyday for two weeks in past year.1 in 11 (9.3%) attempted suicide1 in 9 (13.5%) made a suicide plan1 in 6 (17.2%) seriously considered

attempting suicide.A youth dies by suicide every 4 ½ days in Indiana.

Source: Youth Risk Behavior Survey, 2009

MAGNITUDE OF THE PROBLEM: HIGH SCHOOLERS (2007)

36High School Suicide Deaths (61 deaths ages 20-24)

23,978 High School Youth Suicide Attempts

52,619High School YouthThinking of Suicide

Source: Indiana Youth Risk Behavior Survey, 2007 / Indiana Mortality Report, 2007

YOUTH SUICIDE ATTEMPTS Data for suicide attempts are sparse

Attempts are usually not reported to the Department of Health unless medical attention is necessary

Most hospitals don’t “e-code” their data 1 in 14 (7.2%) reported actually attempting

suicide Parents are usually not aware of non-fatal

attempts unless the attempt caused serious medical consequences

It is estimated that there are 100-200 youth suicide attempts for every completed suicide

Sources: Indiana Youth Risk Behavior System Report, 2007; American Association of Suicidology, 2008.

YOUTH SUICIDE ATTEMPTS Youth account for 28% of suicide

attempts seen in Indiana emergency departments (ED) 63% female 67.8% were poisoning, 24% cutting/piercing

Boys more likely to use hanging or guns Youth account for 15% of suicide

attempts requiring inpatient care Cost during 2003-2005:

ED $16.8 million (Youth = $3.7 million) Inpatient $58 million (Youth = $5.5 million)

Source: Indiana State Department of Health, Injury Prevention Program

YOUTH SUICIDE ATTEMPTS In a typical classroom, 1 boy and 2 girls have

attempted suicide. Latinos attempt suicide more than their white

or African American peers. LGBT youth have higher rates of suicide

attempts than do their straight peers. Youth living with mental illness and juvenile

offenders also have higher rates.

Sources: National Strategy for Suicide Prevention, 2001; John L McIntosh, Indiana University- South Bend; AAS Youth Suicide Fact Sheet; King (1999; 1997, p. 66); CDC.

YOUTH SUICIDAL IDEATION1 in 4 (27.5%) youth felt sad or

hopeless everyday for two weeks in past year

Nearly 1 in 9 (11.7%) made a suicide plan

Nearly 1 in 6 (15.8%) seriously considered attempting suicide52,619 youth in Indiana seriously

considered suicideSource: Indiana Youth Risk Behavior System Report 2007

Who is at Risk?

ALL YOUTH ARE AT RISK

WHAT ARE RISK FACTORS? Risk factors are influences that make

it more likely that individuals will develop a mental health problem.

Risk factors can include biological, psychological, or social factors in the individual, family, or community.

The more risk factors a person has, the more he/she is at risk for suicide and other self-destructive behaviors.

Source: National Strategy for Suicide Prevention, 2001

RISK FACTORS Previous suicide

attempts Depression and/or

alcohol or substance abuse

Family history of mental disorders, substance abuse, suicide

Easy access to guns Exposure to other

teenagers who have died by suicide

Lack of social support and sense of isolation

Stigma associated with help-seeking behavior

Hopelessness Impulsive and/or

aggressive tendencies History of trauma or

abuse

Source: National Strategy for Suicide Prevention, 2001

Protective Factors

PROTECTIVE FACTORS Access to effective clinical care for mental, physical and substance abuse disorders

Easy access to a variety of clinical interventions and support for help

Restricted access to highly lethal means of suicide

Source: National Strategy for Suicide Prevention, 2007

PROTECTIVE FACTORS Strong connections to family and

community support Life skills and resiliency (problem

solving, impulse control, conflict resolution and nonviolent handling of disputes

Cultural and religious beliefs that discourage suicide and promote self-preservation, help-seeking behavior, and inter-dependence

Source: National Strategy for Suicide Prevention, 2007

“…focusing on protective factors such as emotional well-being and connectedness with

family and friends was as effective or more effective than trying to reduce risk factors in

the prevention of suicide.”

Borowsky IW, et al. Suicide attempts among American Indian and Alaska Native youth: risk and protective factors. Archives of Pediatrics and Adolescent Medicine, 1999, 153: 543-547.

Warning Signs

WARNING SIGNSFeeling:

Anxious or agitatedHopelessRage, uncontrolled anger, or seeking revenge

Trapped- like there’s no way out

WARNING SIGNSWithdrawing from friends, family and society

Experiencing dramatic mood changes

Talking or writing about death, dying or suicide when these behaviors are out of ordinary for individual

WARNING SIGNSLooking for lethal means: seeking firearms, pills, etc.

Acting reckless or engaging in risky activities

Seeing no purpose for lifeFeeling they are a burden to others

Threatening to hurt or kill oneself

Source: NAMI, NH, www.naminh.org

WARNING SIGNS – ACUTE CRISIS Getting in significant

trouble in school, at work or with police

Threat of or actual loss of job or financial assets

Fighting with parents, family or friends

Recent loss of a loved one person through death, move, or break-up

Significant changes in family situation such as divorce or physical, emotional, or sexual abuse

DIRECT AND LESS VERBAL CUES

I wish I were dead I’m going to end it

all I’ve decided to kill

myself I believe in suicide If [such and such]

doesn’t happen, I’ll kill myself

You will be better off without me

I’m so tired of it all What’s the point of living? Here, take this. I won’t be

needing this anymore Who cares if I’m dead

anyway How do you become an

organ donor Pretty soon you won’t

have to worry about me

Direct Verbal Cues Less Direct Verbal Cues

TIPS FOR ASKING THE SUICIDE QUESTIONARE YOU THINKING ABOUT HURTING

OR KILLING YOURSELF?If in doubt, don’t wait, ask the questionIf the person is reluctant, be persistentTalk to the person alone in a private

settingAllow the person to talk freelyGive yourself plenty of time

REMEMBER How you ask the question is less important

than that you ask it Research shows that talking about suicide

with a teen in a caring manner will NOT “put the idea in their heads”

They have already been thinking about it – they need you to get them help so they will not act on those thoughts!

RESOURCES & REFERRALS Have your resources immediately

available QPR Card, phone numbers, counselor’s

name and any other information that might help

National Suicide Prevention Lifeline 1-800-273-TALK

Mental Health Resource Sheet – Allen County

What YOUR School Can Do To Prevent

Suicides

WHY SCHOOLS? Potential to prevent suicide and refer youth

to help is great: Reach the highest number of kids Level of student-to-student interaction is high Provides contact with adults who want to help Building help-seeking skills is part of building

healthy youth Schools already have policies to prevent injury

and homicide (the other leading causes of death), why not suicide?

WHY SCHOOLS? Teachers are inadequately trained on issues

surrounding adolescent suicide Most schools do not have training program in

place Teachers who are most likely to have some or

inadequate training still did not feel confident they could identify student at-risk for suicide; only 1 in 10 (9%) felt confident

Training increases educators’ confidence; ability to recognize potentially suicidal student by more than 4 times that of teachers who don’t receive trainingYouth Suicide Prevention School-Based Guide, 2003

PREVENTING SUICIDE IN SCHOOLS CAN…Prevent loss of life

Reveal other school problems such as bullying, substance use that can be addressed

Improve academic achievement

PREVENTION/INTERVENTION RECOMMENDATIONS Update school policies and protocols by using

Lifeline’s School Policy Checklist Integrate suicide prevention, intervention and

postvention into your schools’ crisis response plan The State of Maine has best practices guidelines: http://www.maine.gov/suicide/docs/Guidelines%2010-20

09--w%20discl.pdf

HOW TO GET STARTEDFirst Step Train student service staff in suicide

intervention. Program: Applied Suicide Intervention Skills

Training ASIST is a 2-day evidence-based program that is practice dominated and has a clear, easy to use intervention model. Nurses, guidance counselors, social workers

HOW TO GET STARTED

Second Step Have remaining staff trained in suicide prevention so

they can recognize suicide warning signs, directly address a student exhibiting warning signs, and then refer them to help. Program: QPR or safeTALK or Connect. These programs are 2-

4 hours in length. **We recommend that you have 1-2 staff members become

Trainers in a suicide prevention program. Your Trainer(s) can train the rest of the staff in your building(s) on your time frame. It is more cost effective and sustainable.

**Note: Free evidence-based on-line training for educators is available through the Society for the Prevention of Teen Suicide (http://spts.pldm.com/)

HOW TO GET STARTED

Third Step The Crisis Response Team and key staff

should have suicide postvention training. The training covers best practices for responding to a suicide, the risk of contagion and strategies for reducing this risk, strategies for promoting healing for survivors, and the roles of school staff in postvention response. Connect is the only postvention training on the market.

HOW TO GET STARTED

Fourth Step Program for students

Students need to be able to recognize and respond to either their own suicide risk or a friend’s. There are classroom curricula that can be implemented in Health class.

Programs: Lifelines, SOS, Look Listen Link, H.E.L.P

FREE RESOURCES Free resources (posters, wallet cards, etc) are

available with the National Suicide Prevention Lifeline (1-800-273-TALK (8255)): http://www.suicidepreventionlifeline.org/App_Files/Media/PDF/NSPL_Order_Form.pdf

See Indiana Cares website for information on all of these programs (www.indianacares.org) or call or email for more information 260-481-0533, indianacares@ipfw.edu

What YOU Can Do

YOU CAN PREVENT YOUTH SUICIDEEducate everyone (including yourself!) on warning signs

Be ready, willing and able to interveneEncourage gatekeeper training

Know your mental health services and child psychiatrists/psychologists

HOW TO INTERVENE Ask directly about

suicide Don’t leave person

alone Invite expression or

thoughts, however negative and scary

Focus on present, not past or future

Actively listen Remain calm Ask about whether

they have a suicide plan

Involve others Get them to

someone who can help

THINGS TO CONSIDER WHEN TALKING TO A STUDENT

Do they have a suicide plan and what is the lethality? Do they have access to means? How lethal/reversible is their method? How detailed is their plan? Have they made final “arrangements”?

Giving away cherished possessions Is their pain unbearable? Are they desperate? Are they alone, without resources? Have the made a previous suicide attempt? Do they have a mental health history? Do they have a family history?

WHAT YOU SHOULDN’T DO Don’t be vague

Don’t leave person alone

Don’t imply that their thoughts are silly or unimportant

Don’t make promises, including to keep what you’ve heard a secret

Don’t try to convince them that things are not all that bad

Don’t act alone, involve a professional !

Questions?Contact Information:

Alice Jordan-Miles481.4184 (office)415.0556 (cell)

jordana@ipfw.edu

CRY FOR HELP http://www.pbs.org/wnet/cryforhelp/episodes/

the-film/watch-the-documentary/1/