preventing youth suicide in schools
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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/
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