Youth Suicide Resources and Handouts for Teachers

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  • 8/12/2019 Youth Suicide Resources and Handouts for Teachers

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    Youth Suicide

    Resources:

    awareness,

    prevention,

    intervention,and

    postvention

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    HANDOUT FOR TEACHERS

    Warn ing Signs of Suicidal I deation

    I. BEHAVIORS COMMON TO SUICIDAL ADOLESCENTS TALKING OR SPECULATING ABOUT DEATH, SUICIDE, OR

    FUNERALS, INVOLVEMENT WITH OCCULT PRACTICES

    THREATENING SUICIDE AS REVENGE OR PUNISHMENT FOR GUILT FASCINATION WITH DEATH IN MUSIC, ART, POETRY, AND WRITING

    PUTTING ONE'S LIFE IN ORDER:

    - MAKING A WILL- WRITING GOODBYE NOTES- GIVING AWAY PRIZED POSSESSIONS

    DRAMATIC CHANGES IN :- FRIENDS - APPEARANCE- SCHOOL PERFORMANCE - CONTACTS WITH FAMILY/FRIENDS- SLEEPING AND EATING PATTERNS

    INTENSE INVOLVEMENT IN DRUG OR ALCOHOL ABUSE OVERSEVERAL WEEKS

    PREVIOUS SUICIDE ATTEMPTSII. SITUATIONS COMMON TO SUICIDAL ADOLESCENTS

    HISTORY OF FAMILY CONFLICT:- ABUSE (Physical or Sexual)- SUBSTANCE ABUSE- SEPARATION AND DIVORCE

    DEATH OR SUICIDE OF A CLOSE RELATIVE OR FRIENDLIVING IN A HOME WHERE FIREARMS ARE AVAILABLE

    INVOLVEMENT IN ANTISOCIAL BEHEVIORS OR REPEATEDCONDUCTPROBLEMS

    RECENT EMBARRASSMENT OR LOSS PRESENCE OF AN EDUCATIONAL HANDICAP GENDER ORIENTATION CONCERNS

    III. ATTITUDES COMMON TO SUICIDAL ADOLESCENTS

    LOW SELF ESTEEM FEELINGS OF BEIN'G OVERWHELMED BY PROBLEMS WHICH MOST

    TEENAGERS CAN HANDLE ("HELPLESS VICTIM ").

    IMPULSIVE, POOR PROBLEM SOLVER ANGRY AT THE WORLD DEPRESSED, HOPELESS ABOUT THE FUTURE, HAS GIVEN UP ON

    THE PRESENT

    POOR COMMUNICATOR, USES A "WHAT'S THE USE? APPROACH ANOUTSIDER, NOT CONNECTED TO OTHERS, FEELS ALONE AMBIVALENT

    ABOUT WANTING TO DIE; WANTS AN END TO PAIN.

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    PERSONALITY FACTORS COMMON TO

    SUICIDAL ADOLESCENTS

    * DEPRESSIVE PERSONALITY - both classic depression (apathy, lack of pleasure,loss of energy) and reactive depression (situational)

    * LOW SELF-ESTEEM - feelings of worthlessness- includes unrealistic expectations of oneself

    - loss through embarrassing set back, hypersensitivity

    *HOPELESSNESS - a belief that one lacks control over one's physical and

    psychological well being

    - distrust of one's own resources to solve problems

    - fatalistic view of life

    *LONER PERSONALITY - lack of close relationships, inability to communicate

    - feelings of sexual inadequacy

    *DEPENDENCY - parental pressure to succeed

    - high need for support coupled with inability to obtainsupport from significant others

    - attention seeking goals

    * IMPULSIVITY - tendency to habitually react to stress without thinkingthings through

    - rarely thinks about consequences of suicidal attempt

    *LOW FRUSTRATION - may act out of angerTOLERANCE

    - views the world as "unfair"

    * ACTING OUT/AGGRESSIVE -indicative of anger in background

    - desire to provoke guilt and sympathy in others

    - often a mask for depression

    * COGNITIVE RIGIDITY - "either-or" type of thinking, restricted problem solvingability

    Preventing Adolescent Suicide by Dave Capuzzi, Ph. D.

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    HANDOUT FOR TEACHERS

    THE FOUR RESPONSIBILITIES OF TEACHERSIN RESPONDING TO SUICIDAL THREATS

    1. RECONGNITIONOF THE WARNING SIGNS OF SUICIDAL INTENTION2. RESPONSDINGBY FINDING ANSWERS TO FOUR SPECIFIC QUESTIONS

    ABOUT SUICIDAL INTENT AND/OR BEHAVIOR?

    * DO YOU INTEND TO KILL YOURSELF

    What did you mean when you said,..? What has been happening to make you think about ki ll ing your self ?

    *DO YOU HAVE A PLAN?

    How specif ic is it? How reali stic is it?

    *IN WHAT WAY WOULD YOU TAKE YOUR LIFE?

    How deadly i s the means? Does he have access to a means of self destruction?

    *WHAT CAN I DO TO DISSUADE YOU?

    How determined is he to hur t himself ? Where is he on the scale? I s there anythi ng or anyone who could prevent him f rom suicide?

    3. ACCEPTINGRESPONSIBILITYTO OBTAIN HELP FOR ONE WHO IS SUICIDAL I t is safer to presume that a student i s ser ious when he threatens suicide than to

    dismiss it as an angry outburst or attenti on-seeking behavior.

    Parents must be involved in the process of obtaini ng help. I t is a common exper ience that parents may in iti all y resist the idea that their chil d is

    sui cidal. Explain your professional concerns to them Suicidal behaviors must be

    taken ser iously; the alternative is unthinkable.

    4. MAKINGREFERRALSTO RESOURCESIN YOUR SCHOOL COMMUNITY FORIMMEDIATE ASSESSMENT AND COUNSELING

    The school counselor , in-school cr isis team personnel, and parents What are the mental health r esources in your communi ty? Conf irm that student has obtained help.

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    HANDOUT FOR TEACHERS

    SUICIDE PREVENTION AWARENESS FOR EDUCATORS

    YOU HAVE A RESPONSIBI LI TY TO TAKE ACTION.

    If one of your students threatened suicide or showed other signs of being

    suicidal your reaction and subsequent course of action, could make the differencebetween life and death.

    In our American society, suicide has always been viewed as a shameful,

    dishonorable act. The person who has suicidal thoughts knows this, is ashamed, andis reluctant to tell anyone how he feels. At the time he needs somebody most, he

    fears he will be treated like an outcast if he asks for help. When he fina1ly does revealthe way he feels, he is very sensitive to the reactions of the person in whom he hasconfided. Often he will reveal his intentions indirectly through: warning signs of

    distress.

    WHAT DO YOU SAY TO A SUICIDAL YOUNGSTER?The best thing to do when someone makes suicidal statements is toshow

    concern and to ask questions in a straightforward and calm manner. .

    T ell him you are taking his threat very seriously . Ask what feelings have prompted the desire to suicide. Ask about recent home situations or relations with friends. Ask if the person bas talked with anyone else about suicide. Ask if he or she bas thought about the means of suicide and, if so, if any steps have

    been taken to procure those means.

    Tell him you will help him through this difficult period. Ask if he or she would be interested in speaking confidentially with someone

    additionally who is also very helpful in such situations.

    Your questions accomplish three important goals:

    They show that you are willing to discuss the subject and that you are not appalled ordisgusted by it.

    They will open lines of communication, allowing the student to talk about the way hefeels, which alone may help him to feel better and to believe that someone will help him.

    The questions will help you, and subsequently others, to evaluate the seriousness ofthe problem. (lethality assessment).

    HOW DO YOU KNOWTHE LETHALI TY 0FHI S INTENT?In evaluating the probability that a suicide attempt will be made, be aware

    that as a general rule: " The more specif ic the plan, the greater and more imminent thedanger.If detailed plans have been made and the means of suicide obtained, the danger is not

    only great-it is immediate!

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    HANDOUT FOR TEACHERS, P.2

    The presence of any suicidal i ntention shoul d be considered with cauti on.This does not meanthat someone with only vague suicidal notions should not be taken seriously; he or she may be in

    the early stages of planning, or indeed the act may be carried out impulsively without thecarefully detailed plans that characterize many adult suicides. It doesn't take much planning tograb a gun, jump out a window, or drive into a highway abutment.

    WHAT IS THE COURSE OF ACTION IF I SUSPECT A STUDENT MAY BE SUICIDAL ?

    Your responsibility, even when you receive a third hand report ofa suicidal threat, is to reportwhat you have heard to a school counselor, school psychologist, or agency-based professional

    and the school principal. The parents must be immediately invo lved in a plan of action.Treatment will be based an the level of risk the student seems to present. The following

    recommended interventions are commonly used strategies for those who deal with suicidalyouth.

    LOW RISK FOR SUICIDAL ACTION:

    CALM CONCERN, CONFIDENCE BUILDING NOTIFICATION OF PRINCIPAL AT EVERY LEVEL DISCUSS CONCERNS WITH PARENTS; RECORD RESULTS WRITTEN CONTRACT WITH STUDENT ONGOING CONTRACT WITH YOU/PEERMEDIUM RISK FOR SUICIDAL ACTION:

    NOTIFICATION AND INVOLVEMENT OF PARENTS RECOMMEND OUTSIDE AGENCY RESOURCE MANAGEMENT PLAN AT SCHOOL FOR STUDENT FOLLOW-UP CONTACT WITH PARENTSHIGH RISK FOR SUICIDAL ACTION:

    CONSTANT SUPERVISION AT SCHOOL AND HOME IMMEDIATE INVOLVEMENT OF PARENTS CONFIRMATION OF REFERRAL RESOURCES INVOLVEMENT REMOVAL OF MEANS OF SELF DESTRUCTION

    WHAT PRECIPITATES SUICIDAL THOUGHTS?

    It may be helpful to keep in mind that in any crisis situation the stress process has three parts:

    ? an embarrassing public setback or a traumatic loss; (e.g. Loss of a girlfriend or death of a

    friend)

    ? troubling negative thoughts about self or others (e.g. Im worthless.; They hate me.,Nobody cares.)

    ? attempting to cope with a temporary crisis (e.g. An auto accident) by an impulsive, and at

    times permanent, act of self destruction.

    Adapted from Suicide in Youth and What to Do About It.

    San Mateo County, California

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    HANDOUT

    HOW EDUCATORS CAN HELP SUICIDAL CHILDREN

    Be aware of your responsibilities to know warning signs to protect a suicidal youngster.

    Identify potentially suicidal children using warning signs and referral to school counselors ("highrisk category students.}

    Use proactive strategies to teach children better coping and problem - solving skills throughrealistic problem situations, role plays, and videos.

    Take any suicide attempt, regardless how non-lethal, as a very serious sign that a child has takendesperate measures to let someone know of his distress.

    Alert parents when their children make suicidal threats and direct them to seek appropriate

    mental health resources.

    Consult with parents to seek remedial assistance to improve communication among family

    members and address dysfunctional behavior.

    Let the child know that you understand their hurtful feelings. Encourage them to discuss whatthey are experiencing that has influenced them to consider suicide.

    If you are not able to maintain a relationship with a "high risk" category student, make certainthat the child has a supportive relationship with another adult in the school.

    Work with self destructive middle school aged students to help them assess repetitious,

    alienating behaviors (e.g., Absenteeism, rebelliousness in class, apathy toward work completion,deliberately provocative behavior towards others in the class, etc.). Help them understand howthese behaviors involve them in problems over and again.

    Use a self-structuring response when faced with suicidal behavior.

    "You do not have to hurt yourself to tell methat something is wrong. "

    Set limits when you hear suicidal threats, no matter how causal the intent.

    "Billy, we take it very seriously around here when someone threatens to kill

    himself. Tell me straight out what is wrong. Don't try to get my attention by makingthreats to hurt yourself. Say instead,Mr. Savage, I have a problem, Canyou help me?

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    D-I-R-T

    ASSESSMENT of PREVIOUS SUICIDE ATTEMPTSby YOUNG PEOPLE

    Use the D-I-R-T test to weigh the risk factors of previous suicide attempts:

    S-L-A-P

    LETHALITY ASSESSMENTfor YOUNG PEOPLE

    Have you been thinking of harming yourself?

    If answered in the affirmative, is followed by:

    How would you harm yourself?

    From this point you are assessing lethality of intentions by the use of the S-L-A-P test:

    Youth Suicide

    Barbara Hicks (1990)

    D How dangerous was the previous attempt?

    I What impression did the individual have about the risk of the

    previous attempt?

    R Was the opportunity for rescue possible or remote?

    T Was the previous attempt recent or long ago?

    S How specific is the plan?

    L How lethal is the proposed method?

    A How available is the proposed method?

    P What is the proximity of helping resources?

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    SUICIDE INTERVENTION SCREENING

    When to assess.

    When the counselor hears counselees say,

    "I can't handle it."

    "Id be better off dead.

    "I just don't know what to do or where to turn."

    "I've had it."

    **** Or if you notice any significant combination of suicidal warning signs.

    How to assess.

    The counselor needs to explore these themes by asking,

    1. How much are you thinking about killing yourself? Are you thinkingabout hurting yourself?

    2. What is your method or plan?

    3. Is that method or plan available to you?

    4. Where/when would you do this?

    5. Who would be most affected by your death or to whom would you

    address a suicide note?

    6. On a scale of 1 to 10, one being very unlikely and ten being certain that you will do it,where are you on that scale in your plan to kill yourself?

    7. Who, in addition to me, needs to know how you're feeling right now?What would you want to tell them so that they could understand you better?

    8. Is my being with you helping not at all, a little, or a lot? What would I need to knowabout you in order to help you more ?

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    What to say to a potential ly suicidal counselee:

    1. Tell the person that you don't want him/her to do it.

    2. Don't tell the person that "everything will be all right - you have so much to

    live for." This invalidates 'the individual's feelings. Also, you have no guarantee that

    the person's concern I can be easily fixed or is within his/her control. Try to join withthe individual in a discussion about feelings related to the problem. I can understandhow things might seem so bad that you might have such thoughts. Tell me a bit moreabout them" THEN SHUT UP AND LISTEN!!!

    3. When you have 1istened, respond by focusing on cognition rather than affect.

    Go for problem-solving - try to defuse and calm strong emotions. "Let's figureout what your first step could be." or "Let's see if we can find a way to takecare of one part of this problem."

    What to do:

    1.Suggest a suicide intervention contract, counselee's verbal or written promisenot to hurt oneself while help is being obtained with a specific time to see the

    counselor again the following day.2. Consult with school principal, school counselor, or psychologist.

    3. Contact parent/guardian.4. Recommend family contact with therapist or the community mental health

    center for a lethality assessment.

    5. Recommend family involvement of doctor or caseworker.6. Provide youth with hotline phone number 1-800-422-0009.

    7. Check out necessity and criteria far hospitalization.

    Adapted from:

    Milcinski, T.C. (1993). Counselor Self: Efficiency and Suicide Intervention. Unpublished doctoral dissertation, The University of

    Kansas, Lawrence.

    SUICIDAL ADOLESCENT'S MINDSETSuicidal people are predisposed toward looking for anything which will support theirnegative views of themselves, their situation, those around them, and the world in general Theyanticipate that no one will hear them despite their attempts to make others attend to their pain,

    confusion, and anger.

    SUICIDAL ADOLESCENT'S PROCESSING DEFICIENCIES

    Primitive Thinking: absolutistic irreversible fatalistic anecdotal logic

    Therefore...... COUNSELORS MUST TAKE OVER DECISON-MAKINGFOR SUICIDAL COUNSELEES

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    Emergency Counseling with Suicidal Youth1. Carefully understand the precipitating situation or factors.2. Assess the degree of hopelessness3. Work with tunnel vision," i.e. the person having reduced himse1f to very rigid and

    limited ways of viewing a situation and/or seeing only a very limited number of

    options.

    4. Does the individual have a suicidal plan? How specific is it? Risk rises with the specificity ofthe plan.

    5. Are the means of suicide available? Is there a gun in the home?6. Does the person use drugs or alcohol?7. Has the person made previous attempts? If so, what were the circumstances? Are these

    previous circumstances similar to the current precipitating events?

    8. Is there a family history of suicide and/or depression?9. Bargain for a delay.10. Make a non-suicide contract. Make it specific, have the youngster sign it, and sign it

    yourself as a witness. Make copies for the youngster, yourse1f, and perhaps others.

    11. Increase signal awareness; sensitize the person to cues that he may need to take specific

    actions to compete with suicidal feelings.

    12. Remove the person from the provocative situation.13. Draw significant others into the situation; community resources.

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    Name of Student Date of Initial Report

    School School Counselor's Name

    A. Basic Information

    1. History of Concerns

    2. Family Systems Information

    3. Interventions (include dates) School Counselor Agency/Doctor/Therapist Medications

    4. School Related Issues

    B. Follow-up Case Management

    1. Collaboration with Mental Health Providers

    2. Direct Services to Student

    Counseling Issues to Address8 Cognitive8 Effective

    8 Behavioral

    Support Services8 Group

    8 Team

    3. Consultation with Teachers

    4. Consultation with Family

    5. Peer Involvement

    Case Management Template

    (Suicidal Threats, Gestures, Attempts)

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    NO SUICIDE CONTRACT

    I, a student at

    Name School

    take the responsibility for my welfare and agree not to harm myself in any way. I understand that if I am having

    suicidal thoughts that I agree to call my counselorName

    at .

    Phone No.

    If I cannot reach them, I will call the Crisis Hotline at or I will tell an adult andPhone No.

    get help for myself.

    Student Witness

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    Parent Notification

    Actual Sample of a letter used in a Middle School

    Dear Parents/Guardian:

    It was brought to our attention that your child was expressing thoughts of doing harm to.

    himself/herself. When this occurs, it is our school system's procedure to have that child remain inour physical presence until that child can be released directly to his/her parent or guardian. We

    take every occurrence of a suicidal threat seriously and strongly encourage you to have yourchild evaluated by a certified mental health professional or community mental health agency.The purpose of this evaluation is to determine the lethality of your child's thoughts and toprovide recommendations and assistance.

    Your child may return to school as soon as possible. W e ask that a report from themental health professional who saw your child be shared with his/her school counselor at the

    time your child returns to school.

    Thank you for taking this matter seriously. If we can be of any assistance, please call us

    at .

    Sincerely,

    Additional issues

    Encourage parents to sign a release at agency or mental health treatmentprovider so that counselor has permission to contact same and discusscase.

    Have a list of mental health referral resources, addresses, and telephonenumbers to provide to parents/guardians. Include local ER.

    Record on counselor's calendar/schedule contact with parent/guardian,date and time, and results of discussion.

    Share actions taken with an administrator. Ask him/her to documentconversation, date, time.

    Arrange follow-up meeting with student. It is advisable to continue toinvolve family in follow-up plans. Case conference may be appropriate

    especially for a student returning from institution after a serious suicide

    attempt. Use case management template to guide treatment plan.

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    WHAT ARE PARASUICIDAL BEHAVIORS?

    Parasuicidal behaviors are self-destructive acts which, while there is no conscious attempt to kill

    oneself, place the young person in danger of being killed by the high risk nature of the act or byrelating to individual who are capable of bringing harm to the individual. Engaging inparasuicidal behavior is seen as a prelude to an overt act of suicide. Voluntarily placing one's

    life in harm's way is a nonverbal declaration that one considers his/her life cheap, a throw-away. Such behavior extends to placing oneself in a dangerous situation through refusing to

    consider how vulnerable one becomes when under the influence of drugs and alcohol.

    Faced with the presence of the reality that these acts or choices could result in bodily harm, it is

    important for the helper to inquire of the individual whether these potential dangers wereconsidered. Find out if the individual's response to your question is a suicidally focused responsesuch as, "Who would really miss me? Find out about related behaviors such as polydrug abuse

    or heavy drinking and drugging at the same time. Such behaviors tell you that the individual hascrossed the line between substance abuse and life abuse.

    Rowland L. Savage Governor's Conference on Child Abase November, 1997

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    Suicide Prevention Handbook

    P R E V E N T I N G S U I C I D E

    Teach children how to express emotions and feelings.

    Allow children to share feelings and emotions without fear of embarrassment and show that yourespect their feelings.

    Help children to learn to put differences into perspective and to respect differences in people.

    Anticipate when situations or events may be overwhelming to children and help them to dealwith their concerns.

    Help them to understand that life is full of ups and downs and that down periods are normal and

    temporary.

    Teach them how to make and keep friends and to value friendship.

    Help them to understand that relationships between people change and teach them to deal with

    such changes.

    Help them to understand that everyone makes mistakes and that learning from mistakes is the

    most important part.

    Teach them that asking for help is a sign of strength, not weakness, and that help is available forall problems.

    Teach them how to make decisions and to take responsibility for such decisions. Be sure to teachthem to explore choices and solutions and to examine the possible consequences of act ions.

    Accept them for what they are and learn to change your expectations rather than expecting themto change.

    Let them know that they are unique and special, and most importantly that they are loved.

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    WHAT ARE THE ISSUES IN POSTVENTION?

    Pur pose: The objective is to reduce possible contagion among

    young people after a sui cide of an agemate.

    The loss of a close friend introduces a sense of doubt to once confident young people. They may experience a loss of control over once stable feelings and thoughts:

    8 Anxiety and fear for their own safety can be implied.8 Why did he choose to die? I have just as many problems.

    8 Questions about their own self worth are raised.

    Suicide may be looked upon in a new light -- a possibility for them too. The closer the friendship ties and/or the more alienated the students are to the adult world the

    greater is their risk. Postvention plans should identify those students and provide more

    intensive counseling intervention for them.

    All students can benefit from a postvention talk; death reminds many of related loses in theirlives.

    Intervention following a suicide is to:8 convince students that their loss is recognized.

    8 convey a sense of understanding for the pressures they experience.8 open up channels of communication about their concerns.

    Communication themes to use during a postvention are:8 Feelings of anger, guilt, fear, confusion, shame, indifference, disbelief, blame, and

    unrelated grief are normal bereavement themes.

    8 There are no answers to" why" except he made a terrible choice when there were manyothers open to him.

    8 No one makes" another commit suicide; he "chooses" his death.

    8 We all feel abandoned and cheated by a suicide.

    R.L. Savage 10/99 Archdiocesan Response Team Postvention Fldr

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    SUICIDE PREVENTION MODEL FOR

    ELEMENTARY AGED STUDENTS

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    SUICIDE PREVENTION MODEL

    FOR ADOLESCENTS AND PREADOLESCENTS