part 1 - california state university, sacramento...dr. stephen e. brock & mr. richard lieberman...

Dr. Stephen E. Brock & Mr. Richard Lieberman 1

Suicide Prevention in Schools March 13, 2008

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Suicide Prevention in Schools: Best Practices 2008

Stephen E. Brock, Ph.D., NCSPCalifornia State University SacramentoSchool Psychology Training Program

916 278-5919 / [email protected]://www.csus.edu/indiv/b/brocks/

Richard Lieberman NCSPLos Angeles Unified School District

[email protected]

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Workshop OutlineSuicide1. Statistics2. Prevention3. Risk Assessment 4. Intervention5. Postvention

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Workshop Goals

When you leave this workshop we hope that you will have…1. a better understanding of the magnitude of the

problem of youth suicide.2. considered a variety of suicide prevention

strategies.3. increased your knowledge of suicide risk

assessment.4. increased your knowledge of how schools should

intervene with the student at risk for suicidal behavior.

5. increased your knowledge of how to respond to the aftermath of a completed suicide.

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Part 1

Introduction to the Problem of SuicideGOAL:

Develop a better understanding of the magnitude of the problem of youth suicide.

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National Youth Suicide Statistics

Third leading cause of death among 10 to 24 year olds.*

16.9% of high school students report having seriously considered suicide in the prior 12 months.**

13.0% report having made a suicide plan in the prior 12 months.**

8.4% of high school students report having attempted suicide.**

2.3% indicating that the attempt required medical attention.**

100 to 200 attempts for each completed suicide.***

*Fatal Injury Reports, 2004, http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html**Youth Risk Behavior Survey (2005), www.cdc.gov/HealthyYouth/yrbs/index.htm***McIntosh (2006), Suicide Data Page, http://www.suicidology.org/displaycommon.cfm?an=1&subarticlenbr=21

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Other Suicide Facts: All Age Groups(2005 National Data)

Total number of deaths = 32,6371

11th leading cause of death1

More men die by suicide1

Gender ratio 3.8 male suicides (n = 25,907) for each females suicide (n = 6,730)

Suicide Rate = 11.0/100,000 (males, 17.7; females, 4.5 [3.8:1])1

52.1% of suicides were by firearms. 1,3

Suicide by firearms rate = 5.7Suicide by firearms rate (15-19 yrs) = 3.80Suicide by firearms rate (15-19 yrs male) = 6.47Suicide by firearms rate (15-19 yrs female) = 0.98

Highest suicide rate is among white men over 85 (48.42/100,0003 vs 8.25/100,0001 among 15-19 year olds3).

However the 5th highest rate is among American Indian/Alaskan Native 15-19 year old males3.

1McIntosh (2008, January), Suicide Data Page, http://www.suicidology.org/displaycommon.cfm?an=1&subarticlenbr=212Minino, A. M., Heron, M. P., Smith, B. L. (2006, June 28). Deaths: Final data for 2004. National Vital Statistics Reports, 54(19).

Hyattsville, MD: National Center for Health Statistics. www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19.pdf3 National Center for Injury Prevention and Control (2004), http://webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html



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Suicide Rate Ranges15 to 23.6 (12)12.4 to 15 (10)11.6 to 12.4 (6)10.2 to 11.6 (12)6 to 10.2 (11)

US Suicide Rates by State

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Suicide Rates by State (2005 Data)

Rank State (2004 rank) # Rate1 Montana (2) 206 22.02 Nevada (2) 480 19.93 Alaska (1) 131 19.74 New Mexico (4) 342 17.74 Wyoming (5) 90 17.76 Colorado (6) 800 17.17 Idaho (7) 228 16.08 Arizona (11) 945 15.99 South Dakota (13) 121 15.610 Oregon (10) 560 15.442 California (42) 3,206 8.9National Total 32,637 11.0

Source: McIntosh (2008)

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Female Suicide Rates14.4 to 17.9 (4)10.8 to 14.4 (10)7.2 to 10.8 (15)3.6 to 7.2 (19)0 to 3.6 (40)

Female Suicide Rates by Country

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Male Suicide Rates58.8 to 73.7 (4)44.1 to 58.8 (5)29.4 to 44.1 (6)14.7 to 29.4 (25)0 to 14.7 (48)

Male Suicide Rates by Country

11

0

5

10

15

20

25

30

35

40

45

50

5-9 yrs 10-14yrs

15-19yrs

20-24yrs

25-29yrs

30-34yrs

35-39yrs

40-44yrs

45-49yrs

50-54yrs

55-59yrs

60-64yrs

65-69yrs

70-74yrs

75-79yrs

80-84yrs

85+

Males Females Both Genders

\

US Suicide Rates by Age & Gender(2004 data)

Suic

ide

Rate

(per

100,

000)

Source: NCIPC (2007)

12

0

10

20

30

40

50

60

5-14 yrs 15-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs 65-74 yrs 75+ yrs

Males Females

\

World Suicide Rates by Age & Gender(2000 data)

Suic

ide

Rate

(per

100,

000)

Source: WHO (2002)



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Male Suicide Rates by Age & Ethnicity (2004 data)


0

10

20

30

40

50

60

05-09yrs

10-14yrs

15-19yrs

20-24yrs

25-29yrs

30-34yrs

35-39yrs

40-44yrs

45-49yrs

50-54yrs

55-59yrs

60-64yrs

65-69yrs

70-74yrs

75-79yrs

80-84yrs

85+ yrs

White Black AmI nd/AK Native Asian/Pac Islander All Groups

Suic

ide

Rate

(per

100,0

00)

14

Female Suicide Rates by Age & Ethnicity (2004 data)


0

2

4

6

8

10

12

14

16

05-09yrs

10-14yrs

15-19yrs

20-24yrs

25-29yrs

30-34yrs

35-39yrs

40-44yrs

45-49yrs

50-54yrs

55-59yrs

60-64yrs

65-69yrs

70-74yrs

75-79yrs

80-84yrs

85+

White Black AmI nd/AK NativeAsian/Pac Islander All Groups

Suic

ide

Rate

(per

100,0

00)

15

15-19 Year Old Suicide Rates Over Time

0

2

4

6

8

10

12

14

16

18

20

1950 1960 1970 1980 1990 2000 2004

Male Female Overall


Suic

ide

Rate

(per

100,0

00)

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Percent1 of 9-12 Grade Students with an Injurious Suicide2 Attempt (YRBS)

0

0.5

1

1.5

2

2.5

3

3.5

4

1991 1993 1995 1997 1999 2001 2003 2005

Male Female Total

Perc

ent

1Response is for the 12 months preceding the survey2A suicide attempt that required medical attention

Youth Risk Behavior Survey (2005)

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Percent1 of 9-12 Grade Students with a Suicide Attempt2 (YRBS)

0

2

4

6

8

10

12

14

1991 1993 1995 1997 1999 2001 2003 2005

Male Female Total

Perc

ent

1Response is for the 12 months preceding the survey2A suicide attempt that did not necessarily require medical attention


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Percent1 of 9-12 Grade Students with a Suicide Plan2 (YRBS)

0

5

10

15

20

25

30

1991 1993 1995 1997 1999 2001 2003 2005

Male Female Total

Perc

ent

1Response is for the 12 months preceding the survey2Thought about how they would attempt suicide




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Percent1 of 9-12 Grade Students who Seriously Considered Suicide (YRBS)

0

5

10

15

20

25

30

35

40

1991 1993 1995 1997 1999 2001 2003 2005

Male Female Total

Perc

ent

1Response is for the 12 months preceding the survey


20

Percent1 of 9-12 Grade Students who felt sad or hopless2 (YRBS)

0

5

10

15

20

25

30

35

40

1999 2001 2003 2005

Male Female Total

Perc

ent

1Response is for the 12 months preceding the survey2Almost every day for two weeks or more in a row and as a result stopped doing some usual activities


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Percent1 of 9-12 Grade Students who display suicide related behaviors2 (YRBS)

0

5

10

15

20

25

30

35

1991 1993 1995 1997 1999 2001 2003 2005

Attempt w/ injury Attempt w/o injury Suicide PlanSuicide Thoughts Sad/Hopeless

Perc

ent

1Response is for the 12 months preceding the survey2Both genders Youth Risk Behavior Survey (2005)

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Part 2Suicide Prevention

GOAL:Considered a variety of suicide prevention strategies.

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Primary Prevention: Suicide Prevention PolicyIt 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.

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Primary Prevention:Suicide Prevention Curriculum

SOS: Depression Screening and Suicide Preventionhttp://www.mentalhealthscreening.org/highschool/“The main teaching tool of the SOS program is a video that teaches students how to identify symptoms of depression and suicidality in themselves or their friends and encourages help-seeking. The program's primary objectives are to educate teens that depression is a treatable illness and to equip them to respond to a potential suicide in a friend or family member using the SOS technique. SOS is an action-oriented approach instructing students how to ACT (Acknowledge, Care and Tell) in the face of this mental health emergency.”Evidenced based!



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Primary Prevention:1

Suicide Prevention Screening

School-wide Screening Very few false negativesMany false positives

Requires second-stage evaluation

LimitationsRisk waxes and wanesPrincipals’ view of acceptability Requires effective referral procedures

Possible ToolSuicidal Ideation QuestionnaireAuthor: William ReynoldsPublisher: Psychological Assessment Resources

1Acknowledgement/Reference: Gould, M. S., & Kramer, R. A. (2001). Youth suicide prevention. Suicide and Life-Threatening Behavior, 31 (sup.), 6-31.

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Primary Prevention:Suicide Prevention Screening

http://www.teenscreen.org/

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Suicide Prevention: Gatekeeper Training

Training natural community caregivers(e.g., Suicide Intervention Training)

AdvantagesReduced risk of imitationExpands community support systems

Research is limited but promisingDurable changes in attitudes, knowledge, intervention skills


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Primary Prevention:Suicide Prevention: Gatekeeper TrainingA Specific Training Program:

Applied Suicide Intervention Skills TrainingAuthor: Ramsay, Tanney, Tierney, & LangPublisher: LivingWorks Education, Inc1-403-209-0242http://www.livingworks.net/

The ASIST workshop (formerly the Suicide Intervention Workshop) is for caregivers who want to feel more comfortable, confident and competent in helping to prevent the immediate risk of suicide. Over 200,000 caregivers have participated in this two-day, highly interactive, practical, practice-oriented workshop.Training for Trainers is a (minimum) five-day course that prepares local resource persons to be trainers of the ASIST workshop. Around the world, there is a network of 1000 active, registered trainers.

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Suicide Prevention & Crisis Hotlines

RationaleSuicidal ideation is associated with crisisSuicidal ideation is associated with ambivalenceSpecial training is requires to respond to “cries for help”

Likely benefit those who use themLimitations

Limited research regarding effectivenessFew youth use hotlinesYouth are less likely to be aware of hotlinesHighest risk youth are least likely to use


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Suicide Prevention ResourceThe Surgeon General’s Call to Action to Prevent Suicide 1999

http://www.surgeongeneral.gov/library/calltoaction/default.htm



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Part 3Suicide Risk Assessment

GOAL:Increase your knowledge of suicide risk assessment.

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Myths and Facts Quiz (True or False)1. If you talk to someone about their suicidal feelings

you will cause them to commit suicide.2. When a person talks about killing himself, he's just

looking for attention. Ignoring him is the best thing to do.

3. People who talk about killing themselves rarely commit suicide.

4. All suicidal people want to die and there is nothing that can be done about it.

5. If someone attempts suicide he will always entertain thoughts of suicide.

6. Once a person tries to kill himself and fails, the pain and humiliation will keep him from trying again.

Sources: Giffen, Mary, M.D. and Carol Felsenthal. A Cry For Help. Doubleday and Col, 1983.Miller, Marv. Training Outline for Suicide Prevention. The Center for Information on Suicide. San Diego, California, 1980.

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Recognizing the Need for a Suicide Risk 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.

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Suicide Intervention Risk Factors

PsychopathologyAssociated with 90% of suicidesPrior suicidal behavior the best predictorSubstance abuse increases vulnerability and can also act as a trigger

FamilialHistoryStressorFunctioning

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BiologicalReduced serotongenic activity

Situational40% have identifiable precipitantsA firearm in the homeBy themselves are insufficientDisciplinary crisis most common

Suicide Intervention Risk Factors

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Variables That Enhance Risk

Adolescence and late lifeBisexual or homosexual gender identityCriminal behaviorCultural sanctions for suicideDelusionsDisposition of personal property

Divorced, separated, or single marital status Early loss or separation from parentsFamily history of suicideHallucinationsHomicideHopelessnessHypochondriasis



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Suicide Intervention Warning Signs

VerbalMost individuals give verbal clues that they have suicidal thoughts. Clues include direct ("I have a plan to kill myself”) and indirect suicide threats (“I wish I could fall asleep and never wake up”).

Behavioral

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Verbal Clues1. “Everybody would be better off if I just weren’t around.”2. “I’m not going to bug you much longer.”3. “I hate my life. I hate everyone and everything.”4. “I’m the cause of all of my family’s/friend’s troubles.”5. “I wish I would just go to sleep and never wake up.”6. “I’ve tried everything but nothing seems to help.”7. “Nobody can help me.”8. “I want to kill myself but I don’t have the guts.”9. “I’m no good to anyone.”10. “If my (father, mother, teacher) doesn’t leave me alone

I’m going to kill myself.”11. “Don’t buy me anything. I won’t be needing any (clothes,

books).”


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Behavioral Clues1. Writing of suicidal notes2. Making final arrangements3. Giving away prized possessions4. Talking about death5. Reading, writing, and/or art about death6. Hopelessness or helplessness7. Social Withdrawal and isolation8. Lost involvement in interests & activities9. Increased risk-taking10. Heavy use of alcohol or drugs


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Behavioral Clues (continued)11. Abrupt changes in appearance12. Sudden weight or appetite change13. Sudden changes in personality or

attitude14. Inability to concentrate/think rationally15. Sudden unexpected happiness16. Sleeplessness or sleepiness17. Increased irritability or crying easily18. Low self esteem


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Behavioral Clues (continued)19. Dwindling academic performance20. Abrupt changes in attendance21. Failure to complete assignments22. Lack of interest and withdrawal23. Changed relationships24. Despairing attitude


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Asking the “S” Question

The presence of suicide warning signs, especially when combined with suicide risk factors generates the need to conduct a suicide risk assessment.A risk assessment begins with asking if the student is having thoughts of suicide.



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Identification of Suicidal Intent

Be direct when asking the “S” question.BAD

You’re not thinking of hurting yourself, are you?

BetterAre you thinking of harming yourself?

BESTSometimes when people have had your experiences and feelings they have thoughts of suicide. Is this something that you’re thinking about? 44

Predicting Suicidal Behavior (CPR++)(Ramsay, Tanney, Lang, & Kinzel, 2004; )

Current plan (greater planning = greater risk).

How (method of attempt)?How soon (timing of attempt)?How prepared (access to means of attempt)?

Pain (unbearable pain = greater risk)How desperate to ease the pain?

Person-at-risk’s perceptions are key

Resources (more alone = greater risk)Reasons for living/dying?

Can be very idiosyncraticPerson-at-risk’s perceptions are key

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Predicting Suicidal Behavior (CPR++)(Ramsay, Tanney, Lang, & Kinzel, 2004)

(+) Prior Suicidal Behavior?of self (40 times greater risk)of significant othersAn estimated 26-33% of adolescent suicide victims have made a previous attempt (American Foundation or Suicide Prevention, 1996).

(+) Mental Health Status?history mental illness (especially mood disorders)linkage to mental health care provider

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Risk Assessment and Referral

Suicide Risk Assessment Summary

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Risk AssessmentSuicide intervention script

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Interviewing the Suicidal ChildQuestions to ask in the evaluation of suicidal risk in children1. Suicidal fantasies or actions:

Have you ever thought of hurting yourself?Have you ever threatened or attempted to hurt yourself?Have you ever wished or tried to kill yourself?Have you ever wanted to or threatened to commit suicide?

2. Concepts of what would happen:What did you think would happen if you tried to hurt or kill yourself?What did you want to have happen?Did you think you would die?Did you think you would have severe injuries?



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Part 4School-Based Suicide Intervention

GOAL:Increase your knowledge of how schools should intervene

with the student at risk for suicidal behavior.

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School-Based Suicide Intervention

General Staff Procedures The actions all school staff members are responsible for knowing and taking whenever suicide warning signs are displayed.

Risk Assessment and Referral The actions taken by school staff members trained in suicide risk assessment and intervention.

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Responding to a Suicide Threat.A student who has threatened suicide must be carefully observed at all times until a qualified staff member can conduct a risk assessment. The following procedures are to be followed whenever a student threatens to commit suicide.

Suicide Intervention General Staff Procedures

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1. Stay with the student or designate another staff member to supervise the youth constantly and without exception until help arrives.

2. Under no circumstances should you allow the student to leave the school.

3. Do not agree to keep a student's suicidal intentions a secret.

4. If the student has the means to carry out the threatened suicide on his or her person, determine if he or she will voluntarily relinquish it. Do not force the student to do so. Do not place yourself in danger.


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5. Take the suicidal student to the prearranged room.

6. Notify the Crisis Intervention Coordinator immediately.

7. Notify the Crisis Response Coordinator immediately.

8. Inform the suicidal youth that outside help has been called and describe what the next steps will be.


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Risk Assessment and Referral1. Identify Suicidal Thinking

2. From Risk Assessment Data, Make Appropriate Referrals

3. Risk Assessment Protocol

a) Conduct a Risk Assessment.

b) Consult with fellow school staff members regarding the Risk Assessment.

c) Consult with County Mental Health.



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4. Use risk assessment information and consultation guidance to develop an action plan. Action plan options are as follows:

A. Extreme RiskIf the student has the means of his or her threatened suicide at hand, and refuses to relinquish such then follow the Extreme Risk Procedures.

B. Crisis Intervention ReferralIf the student's risk of harming him or herself is judged to be moderate to high then follow the Crisis Intervention Referral Procedures.

C. Mental Health ReferralIf the student's risk of harming him or herself is judged to be low then follow the Mental Health Referral Procedures.


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A. Extreme Risk

i. Call the police.

ii. Calm the student by talking and reassuring until the police arrive.

iii. Continue to request that the student relinquish the means of the threatened suicide and try to prevent the student from harming him-or herself.

iv. Call the parents and inform them of the actions taken.


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B. Crisis Intervention Referral

i. Determine if the student's distress is the result of parent or caretaker abuse, neglect, or exploitation.

ii. Meet with the student's parents.

iii. Determine what to do if the parents are unable or unwilling to assist with the suicidal crisis.

iv. Make appropriate referrals.


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C. Mental Health Referral

i. Determine if the student's distress is the result of parent or caretaker abuse, neglect, or exploitation.

ii. Meet with the student's parents.iii. Make appropriate referrals.

• Protect the privacy of the student and family.

• Follow up with the hospital or clinic.


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Part 5School-Based Suicide Postvention

GOAL:increased your knowledge of how to respond to the aftermath

of a completed suicide.

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DefinitionsSuicide “Postvention”...Postvention is the provision of crisis intervention, support and assistance for those affected by a completed suicide.

“Affected” individuals...“Affected” individuals may include classmates, friends, teachers, counselors, and family members.

“Survivors” of Suicide...Affected individuals are often referred to as “survivors”of suicide.



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Preface

“…the largest public health problem is neither the prevention of suicide nor the management of suicide attempts, but the alleviation of the effects of stress on the survivors whose lives are forever altered.”

E. S. ShneidmanForward to Survivors of SuicideEdited by A. C. CainPublished by Thomas, 1972

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PrefaceBased on the 754,570 suicides from 1980 to 2004, it is estimated that the number of survivors of suicides in the U.S. is 4.5 million (1 of every 65 Americans in 2004). This number grew by at least 194,634 in 2004.

John L. McIntosh (2006), Suicide Data Page, http://www.suicidology.org/displaycommon.cfm?an=1&subarticlenbr=21

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Special Suicide Postvention Issues

1. Suicide ContagionAvoid sensationalism of the suicide.Avoid glorification or vilification of the suicide victim.Do not provide excessive details.

2. Emotional ResponseGuilt and shame

3. Social ExperienceRejection and isolation

4. Suicide Bereavement Response/Experience (vs. naturally bereaved; De Groot et al., 2006)

Poorer physical, emotional, and social functioning 64

Special Suicide Postvention Issues

5.Social StigmaBoth students and staff members may be uncomfortable talking about the death.Survivors may receive (and/or perceive) much less social support for their loss.Approximately half of survivors close friends report a more strained/distant relationship (Norford, 2005).

Reluctance to provide postvention services.

Suicide postvention must be prepared to operate in an environment that is not only suffering from a sudden and unexpected loss, but one that is also anxious talking openly about the death.

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Developmental Issues1.It is not until the fifth grade that students

have a clear understanding of what the term “suicide” means and are aware that it is a psychosocial dynamic that leads to suicidal behavior.

2.While primary grade children appear to understand the concept of “killing oneself,”they typically do not recognize the term “suicide” and generally do not understand the dynamics that lead to this behavior.

3.The risk of suicidal ideation and behaviors increases as youth progress through the school years.

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Cultural Issues

Attitudes toward suicidal behavior vary considerably from culture to culture.

While some cultures may view suicide as appropriate under certain circumstances, other have strong sanctions against all such behavior.



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General Suggestions for Helping SurvivorsBoth survivors and educators need support.

Survivors need …support groups.support from outside of the family.to be educated about the psychodynamics of grieving.to be contacted in person instead of by letter or by phone after the suicide

Grad et al., 200468

General Suggestions for Helping Survivors

Awareness among educators of the needs of survivors.Using someone as a scapegoat does not help.Educate school-based mental health professionals how to support survivors and support each other.

“It is absolutely necessary to train professionals, firstly to acknowledge their own feelings, and secondly to cope with them after the loss of their patient” (p. 139).

Grad et al., 2004

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Suicide Postvention Protocol

1. Preparedness is an essential component of effective postvention.

2. Make sure that a postvention is needed before initiating this intervention.

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Suicide Postvention Checklist1. Verify that a death has occurred.2. Mobilize the Crisis Response Team.3. Assess the suicide’s impact on the school and estimate the

level of postvention response.4. Notify other involved school personnel.5. Contact the family of the suicide victim.6. Determine what information to share about the death.7. Determine how to share information about the death.8. Identify students significantly affected by the suicide and

initiate a referral mechanism.9. Conduct a faculty planning session.10. Initiate crisis intervention services.11. Conduct daily planning sessions.12. Memorials.13. Debrief the postvention response.

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Item 2:Mobilize the Crisis Response Team

Crisis Response CoordinatorVerifies that at death has occurred.Mobilizes the crisis response team.Oversees all postvention interventions.

Crisis Intervention CoordinatorIdentifies individuals in need of postvention assistance.Plans and implements interventions.Coordinates crisis intervention workers.

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Item 2:Mobilize the Crisis Response Team

Media LiaisonProvides access to information.Controls rumors.Deals with the media.

Medical LiaisonKeeps the crisis response team informed of victim’s medical status.

Security LiaisonResponsible for crowd control.Monitors common areas.Communicates with law enforcement.



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Item 3:Assess the Suicide’s Impact on the School and Estimate the Level of Postvention Response

The importance of accurate estimates.

Temporal proximity to other traumatic events (especially suicides).

Timing of the suicide.

Physical and/or emotional proximity to the suicide.

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Item 5:Contact the Family of the Suicide Victim

1. Contact should be made in person within 24 hours of the death.

2. Purposes include...Express sympathy. Offer support.Identify the victim’s friends who may need assistance.Discuss the school’s postvention response.Identify details about the death could be shared with outsiders.

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Item 6:Determine What Information to Share About the Death

1.The longer the delay in sharing facts, the greater the likelihood of harmful rumors.

2.Several different communications will likely need to be offered.

Before a death is certified as a suicide.After a death is certified as a suicide.Provide facts and dispel rumors.Do not provide suicide method details.

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Item 7:Determine How to Share Information About the Death

1. Reporting the death to students...Avoid sharing information about the death over a school's public address system.Avoid school wide assemblies.Provide information simultaneously in classrooms.

2. Reporting the death to parents...Written memos.Personal or phone contacts.

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Item 7:Determine How to Share Information About the Death

Working with the media...The Media Liaison should work with the press to down play the incident .It is essential that the media not romanticize the death.The media should be encouraged to acknowledge the pathological aspects of suicide.Photos of the suicide victim should not be used.“Suicide" should not be placed in the caption .Include information about the community resources. 78

Item 8:Identify Students Significantly Affected by the Suicide and Initiate Referral Procedures

Risk Factors for Imitative BehaviorFacilitated the suicide.Failed to recognize the suicidal intent.Believe they may have caused the suicide.Had a relationship with the suicide victim.Identify with the suicide victim.Have a history of prior suicidal behavior.Have a history of psychopathology.Shows symptoms of helplessness and/or hopelessness.Have suffered significant life stressors or losses.Lack internal and external resources.

Note. Adapted from information provided by American Association of Suicidology (1998); Brent et al. (1989); Davidson (1989); Davidson, Rosenberg, Mercy, Franklin, & Simmons (1989); Gould (1992); O'Carroll et al. (1988); Ruof and Harris (1988); and Sandoval & Brock (1996).



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Item 9:Conduct a Staff Planning Session

1. Staff should be provided...current information regarding the death.if available, news articles about the death.information about suicide contagion.suicide risk factors.plans for the provision of crisis intervention services.

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Item 9:Conduct a Staff Planning Session

2. Specific activities/responsibilities for teachers include...

replacing rumors with facts.encouraging the ventilation of feelings.stressing the normality of grief and stress reactions.discouraging attempts to romanticize the suicide.identifying students at risk for an imitative response.knowing how to make the appropriate referrals.

3. Address staff reactions.

4. Staff members should be given permission to feel uncomfortable.

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Item 10:Initiate Crisis Intervention Services

1.Intervention options...Individual meetings.Group psychological first aid.Classroom activities and/or presentations.Parent meetings.Staff meetings.Referrals to community agencies.

2.Walk through the suicide victim’s class schedule.

3.Meet separately with individuals who were proximal to the suicide.

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Item 10:Initiate Crisis Intervention Services

4.Identify severely traumatized and make appropriate referrals.

5.Facilitate dis-identification with the suicide victim...

Do not romanticize or glorify the victim's behavior or circumstances.Point out how students are different from the victim.

6.Parental contact.

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Crisis Intervention Procedures Following a Suicide

1. Without excessive detail, provide students with the facts about the suicide.

2. State that the only one ultimately responsible for the suicide is the victim.

3. Acknowledge the suicide was an avoidable and poor choice. Portray the act as a permanent solution to temporary problems.

4. Discuss how survivors are different from the suicide victim. Portray the suicide victim as very upset, disturbed, and as someone who had not found an effective way to work out problems. Help survivors to dis-identify with the suicide victim (without abusing the victim's character).

5. Facilitate the expression of feelings about the suicide.

Adapted from information provided by American Association of Suicidology (1998); Berman & Jobes (1991); Davis & Sandoval (1991);O’Carroll et al. (1988); Poland & McCormick (1999); and Ruof and Harris (1988).

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Crisis Intervention Procedures Following a Suicide

6. State that there is no “right way” to feel after a suicide.

7. Point out that painful reactions to the suicide will be alleviated with time and talk.

8. Acknowledge that people may have suicidal thoughts following the suicide of a significant other.

9. Provide information about the warning signs of suicidal behavior and available mental health resources.

10. If appropriate, prepare students for the funeral.

Adapted from information provided by American Association of Suicidology (1998); Berman & Jobes (1991); Davis & Sandoval (1991); O’Carroll et al. (1988); Poland & McCormick (1999); and Ruof and Harris (1988).



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Item 12:Memorials

Do not . . .send all students from school to funerals, or stop classes for a funeral.have memorial or funeral services at school.put up plaques in memory of the suicide victim, or dedicate yearbooks, songs, or sporting events to the suicide victims.fly the flag at half staff.have assemblies focusing on the suicide victim, or have a moment of silence in all-school assemblies.

From “Suicidal Ideation and Behaviors” (p. 327), by S. E. Brock & J. Sandoval. In C. G. Bear, K. M. Minke, & A. Thomas, Children’s Needs II: Development, Problems, and Alternatives, 1997, Bethesda, MD: National Association of School Psychologists. Copyright 1997 by the National Association of School Psychologists. Adapted with permission.

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Item 12:Memorials

Do . . .something to prevent other suicides.develop living memorials, such as student assistance programs, that will help others cope with feelings and problems.allow students, with parental permission, to attend the funeral.encourage affected students, with parental permission, to attend the funeral.mention to families and ministers the need to distance the person who committed suicide from survivors and to avoid glorifying the suicidal act.

From “Suicidal Ideation and Behaviors” (p. 327), by S. E. Brock & J. Sandoval. In C. G. Bear, K. M. Minke, & A. Thomas, Children’s Needs II: Development, Problems, and Alternatives, 1997, Bethesda, MD: National Association of School Psychologists. Copyright 1997 by the National Association of School Psychologists. Adapted with permission.

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Item 13:Debrief the Postvention Response

Goals will include...

Review and evaluation of all crisis intervention activities.

Making of plans for follow-up actions.

Providing an opportunity to help intervenors cope.

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Suicide Postvention ResourcesHandout

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Concluding Thought“…the person who commits suicide puts his psychological skeleton in the survivor’s emotional closet; he sentences the survivor to deal with many negative feelings and more, to become obsessed with thoughts regarding the survivor’s own actual or possible role in having precipitated the suicidal act or having failed to stop it. It can be a heavy load.” (p. 154)

E. S. Shneidman (2001)

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Suicide Prevention in Schools: Best Practices 2008

Stephen E. Brock, Ph.D., NCSPCalifornia State University SacramentoSchool Psychology Training Program

916 278-5919 / [email protected]://www.csus.edu/indiv/b/brocks/

Richard Lieberman NCSPLos Angeles Unified School District

[email protected]

part 1 - california state university, sacramento...dr. stephen e. brock & mr. richard lieberman...

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