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Suicide is Personal
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who miss our friends and relativesSome may be attempt survivorsPlease take care of yourself during this training!
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DefinitionsSuicide-Self-injury with the intent to
cause deathWorld Health Organization
Survivor-Those left behind (families, friends, etc.)
Contagion- suicidal behavior is imitated by one or more individuals following the awareness of a recent threat, attempt, or completion
Oklahoma2010 - 618 suicide deaths – 13th highest Oklahoma’s =16.5 U.S. = 12.4 (1)
Suicide and Homicide Statistics (2004-2009) (2)
• 3,203 deaths by suicide were reported• 1,322 homicides
• On average 534 die by suicide annually• On average 220 deaths by homicide
annually
1.) American Foundation for Suicide Prevention http://www.afsp.org/index.cfm?fuseaction=home.viewPage&page_id=05114FBE-E445-7831-F0C1494E2FADB8EA2.) Summary of Violent Deaths in Oklahoma; Oklahoma Violent Death Reporting System, 2004-2009
Oklahoma
• Suicide rates highest in the 25-64 age group
• 79% of suicide victims are male, 21% are female
• The rate of suicide completion is higher for males than females across all categories of race and age.
• Overall rate for males increased 12% from 22.3 in 2004 to 25 in 2009 (2% annual increase)
• Male suicide rates increased 27% among persons 45-64 and 22% among persons 25-44 (5% and 4% average annual increases respectively)
Summary of Violent Deaths in Oklahoma; Oklahoma Violent Death Reporting System, 2004-2009
Oklahoma
Of those that lost their lives to suicide, 23% served in the US Armed Forces.
Suicide rate among veterans 65 years and older decreased 27%, while the suicide rate among veterans 35-44 increased 67%.
Firearms (60%), hanging/strangulation (19%), poisoning (18%).
Summary of Violent Deaths in Oklahoma; Oklahoma Violent Death
Reporting System, 2004-2009
Second leading cause of death among youth in Oklahoma.
One out of 53 high school students (1.9 percent) reported having made a suicide attempt that was serious enough to be treated by a doctor (Nationally).
For each suicide death -100–200 suicide attempts.
1 out of every 15 high school students attempts suicide each year.
CDC, 2010a
Proving the Case for Prevention
Second leading cause of death among youth in Oklahoma.
One out of 53 high school students (1.9 percent) reported having made a suicide attempt that was serious enough to be treated by a doctor (Nationally)
For each suicide death -100–200 suicide attempts
1 out of every 15 high school students attempts suicide each year
CDC, 2010a
Proving the Case in our Schools
Suggested DialogueSay this Not this
• We often wonder why someone would take their life, we know they must have been in a lot of pain
• Suicide is a selfish decision
• When people are stressed, hurt, or depressed they only know they want the pain to stop
• He/she made a bad decision
Always be mindful those around you may have lost someone to suicide and may have attempted.
After An Event Gatekeeper trainings for adults National Suicide Prevention Lifeline
placement Office box Debriefing Community small trainings Support groups Extra mental health supports
Crisis Management Preparation to Deal effectively with multiple pressures from
various sources Specific detailed plan Uniqueness of each event Provide management of information to the
community Avert contagions
Team Preparation All members trained in a gatekeeper training Members trauma trained Schedule initial meeting to develop plan Schedule quarterly meetings Revisit policies Update resources Revise/develop referral protocols Commitment of team Ensure annual gatekeeper trainings for key staff
including staff resources how to talk with youth about suicide
Role Possibilities Administration Team leader Information coordinator Parent Liaison Administrative Liaison Student Wellness Coordinator Operations Coordinator Faculty Support Coordinator Community Liaison Student Crisis Assessment Team for those at risk
(referrals, parent meetings, etc.) Back ups for each position
Crisis ResponseThe Crisis Response Team Ten to 15 people chosen for their skills, credentials,
and ability to work compassionately and effectively under pressure—
Administrators Counselors Social workers Psychologists Nurses School resource officers Faith community Local law enforcement
Crisis Response Checklist Confirm death/Inform the school superintendent Contact the deceased’s family to offer condolences,
inquire what the school can do Call an immediate meeting of the Crisis Response
Team Immediately notify faculty and staff of the death
(usually phone or e-mail). Schedule all-staff meeting ASAP Notify students in first hour class Prepare script to be delivered by first hour teacher
(get replacement for teachers not able to make announcement)
Decide who will follow the deceased person’s schedule
Crisis Response ChecklistOperations Assign a staff to follow the deceased student’s schedule Arrange for several substitute teachers or “floaters”
from other schools Arrange for care stations, for staff and students. Provide tissues and water throughout the building Watch the school environment Prepare to track and respond to student and/or family
requests for memorialization.
Community PartnersCoroner/medical examinerPoliceMayor’s office/local governmentMental health and medical communitiesGrief support organizations, to plan for service
needsArranging for outside trauma responders
Crisis Response ChecklistFuneral Communicate logistics, including the need for crisis
counselors and/or security to be present at the funeral.
Importance of communicating with clergy, contagion, etc.
Keep school open if the funeral is during school hours Back up staff at school Arrange for counselors/school staff to attend the
funeral. Encourage parents to accompany their child to the
funeral. Team staff to be present at funeral home during
visitation.
Crisis Response ChecklistMedia Relations Prepare a media statement. Designate a sole media spokesperson Advise students to avoid interviews with the
media. Refer media outlets to Reporting on Suicide:
Recommendations for the Media.Social Media Oversee school’s use of social media as part
of the crisis response. Convene a small group of students to work
with school administration to monitor social networking sites and other social media.
Crisis Response Checklist Draft death notification statement for parents,
including resources. Provide handouts on Facts About Suicide and
Mental Disorders in Adolescents and Talking About Suicide to faculty.
Crisis team debrief every day Care stations for students (time period) Announce care stations hours and locations Ask for outside help Send letter to parents Ensure letter is also placed on the webpage Monitor social media
Crisis Response ChecklistSafety Keep to regular school hours. Ensure that students follow established dismissal
procedures. Call on school resource officers to assist parents and
others. Pay attention to students who are having particular
difficulty
First day(called special faculty meeting) Allow at least one hour to address the following goals: Introduce Team Share accurate information Allow staff to express their own reactions and grief. Provide scripted death notification Prepare for student reactions and questions by
providing handouts to staff on Talking About Suicide and Facts About Suicide and Mental Disorders in Adolescents.
Explain plans for the day, including locations of care rooms.
School climate-changes in behavior among the students
Brief staff on referral process Apprise staff of any outside responders. Remind staff to allow students to go to the care
stations Remind staff of student dismissal protocol for funeral.
End of first day
Hold all staff debrief Offer verbal appreciation of the staff. Review the day’s challenges and successes. Debrief, share experiences, express concerns, and
ask questions. Disseminate information regarding the death and/or
funeral arrangements. Discuss plans for the next day. Self-care. Avoid tests
Get the Facts First Confirm the death. (Principal or ?)
If the Cause of Death Is UnconfirmedRumors-harmful for everyone
Family may not want it labeled a suicideStudents may already be talking
Administration to talk/consult with the family
Team Leader
Team Leader Makes team assignments Coordinate with administration Schedules debriefings Schedules breaks Maintains documents and protocols Leads faculty meetings/debrieings
Information Provides media statements or coordinates with
district assigned media spokesperson Provides media with best practices for reporting Checks with families about facts and their wishes Provides information about funerals, etc. Determines level of information and message youth
receive Provides script to be given to youth via their first
hour teacher Maintains media files Provides best practices for social media messages,
youth discussions, parent prevention strategies for media
Ensures the 800-273-Talk number is posted in schools, scrolling messages, etc.
“The family has requested that information about the cause of death not be shared at this time”
“We know there has been a lot of talk about whether this was a suicide death. Since the subject of suicide has been raised, we want to take this opportunity to give you accurate information about suicide in general, ways to prevent it, and how to get help if you or someone you know is feeling depressed or may be suicidal.”
Emergency Faculty Meeting First thing after the death Relay family wishes Introduce people who will be in the building Explain front office staff roles for the next few
days Provide staff with referral procedures Introduce locations of Care Stations Provide staff with script Provide them with agenda for the first day
after the suicide(traumatic death) Ensure all missing school staff receive
information SELF CARE…. Provide end of school debrief
Parent Liaison
Provides resources, materials for parents
Answers inquiries from parents Host parent meetings Provides resources for parents on the
school web page (access number, materials discussing grief and how to help your child)
Providing take home letters
Coordinator of student care stations manages logistics of locations, staffing,
and protocol for dismissing students to care stations
Community Liaison informs relevant community agencies of
the school’s plans; arranges for community volunteers to
augment school team if necessary contacts off-campus referral resources
to alert them to potential referrals Reaches out to clergy
Physical Logistics Coordinator Addresses all issues that affect the
physical school building Arranges facility setups for meetings Deals with extended school hours,
evening meetings
Faculty Support Coordinator at least two members follow the daily
schedule of the deceased and siblings; are available to
answer faculty questions; provide support to the faculty
if not done by community team member
Critical Climate Oversight two or more members of the team
coordinate crisis contacts with vulnerable students
Administrative Liaison Distributes scripts for phone responses
and directs staff Who answer phones; distributes
information to faculty Coordinates meeting room and faculty
support room assignments manages rumors
Helping Students CopeKEY CONSIDERATIONS Emotional regulation - a person’s ability to express
intense emotions such as grief and fear. Adolescents have mastered basic skills
encountered daily Challenged in the face of a suicideComplex feelings - physical indicators (stomach upset, restlessness, or insomnia)Increased risk for difficulties with emotional
regulation Opportunities to express their emotions Meetings with Students in Small Groups Adjust the regular academic schedule. Have counselors go into the classrooms to give
students accurate information about suicide Provide safe reporting
Helping Students Cope Help Students Identify and Express Their Emotions Emotional expression-anger, humor, silence, etc.
What is your biggest concern about the I immediate future?
What would help you feel safer right now?
Practical Coping Strategies simple relaxation, such as taking three deep slow breaths engaging in favorite activities or hobbies exercising reminding themselves that they can use coping skills list people they can turn to list things they’re looking forward to focusing on individual goals Students should also be encouraged to think about how
they want to remember their friend.
Working with the Community Suicide happens in communities, not just in
schools Engage mental health providers Coroner/Medical Examiner Faith community Media-Educate the community about the
causes and complexity of suicide and to identify available mental health resources.
Law Enforcement First Responders-EMT Funeral directors SOS groups
Memorialization All deaths the same way-alleviate stigma Contagion Funerals School newspapers Desks/ lockers/uniforms Events Permanent memorials/scholarships (for everyone,
forever?) Graduation Memorials
t-shirtsyearbook adscandle light vigils (ongoing)
Creative ideasOut of Darkness Walksa day of community serviceVolunteering on crisis lineSuicide awareness campaign
Social Media Involve Students Disseminate Information Schools website and/or an online
presence The funeral or memorial service Where students can go for help or meet
with counselors Resource numbers 800-273-TALK
Suicide Contagion What is it? How do you prevent it? Identifying Other Students at Possible Risk for Suicide Of special concern are those students who:
-have a history of suicide attempts-are dealing with stressful life events such as a death
or divorce in the family-were eyewitnesses to the death-are family members or close friends of the deceased -received a phone call, text, or other communication from the deceased foretelling the suicide-may have fought with or bullied the deceased
Encourage screenings for those at heightened risk by using a mental health screening
Connect with Mental Health providers Monitor media coverage
Bringing in Outside Help Build a local coalition-toolkit
National Emergency Assistance Team of the National Association of School Psychologists http://www.nasponline.org/resources/crisis_safety/neat.aspx
The Dougy Center: National Center for Grieving Children & Families http://www.dougy.org
Riverside Trauma Center http://www.riversidetraumacenter.org
Boston Children’s Foundation http://www.bostoncf.org
Going Forward Lifeline’s programs
Suicide awareness programs to educate teachers and other school personnel
Programs to educate students themselves about depression, anxiety, substance abuse, and conduct disorder
Gatekeeper training programs, which teach practical skills
Best Practices Registry for Suicide Prevention (BPR), maintained by SPRC and AFSP and available at http://www.sprc.org.
Another source is the National Registry of Evidence-Based Programs at http://www.nrepp.samhsa.gov.
Creating school strategies
General Considerations• Treat All student deaths in the same way.
Why? Stigma, family, friends
• Schools should be aware that adolescents are vulnerable to the risk of suicide contagion.
Why? Glamorization, Copy cat
• The student who died by suicide was likely struggling with a mental anguish.
? You cannot always see what may be happening-substance abuse, anxiety, etc.
• Help is available for any studentWhy? Although we may think everyone is ok, we never know what the event may have triggered.
ResourcesNational Suicide Prevention Lifeline
800-273-TALK
ODMHSAS405-522-3835
www.odmhsas.org
Resource Centerhttp://ok.gov/odmhsas/Prevention_/
E-Prevention_Resource_Center/index.html
After a School Suicidehttp://ok.gov/odmhsas/Prevention_/
Prevention_Initiatives/Youth_Suicide_Prevention_and_Early_Intervention_Initiative/index.html
Tom Thomson405-522-3908
[email protected] Specialist
For additional questions
Tracy McKeown MPH405-419-4142
Julie Geddes405-522-3835
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