Responses and Prevention in Student Suicide: The RaPSS Study Nicky Stanley

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Responses and Prevention in Student
Suicide The RaPSS StudyNicky Stanley
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Methodology

• HEIs across UK
• 20 case studies of student suicide occurring
  between May 2000 and June 2005
• 9 Parents Perspectives Interviews
• 4 Friends Perspectives Interviews
• 10 Positive Practice Interviews

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Distinguishing characteristics of study

• A focus on prevention and responses
• A focus on the student experience
• Multiple perspectives
• An emphasis on interventions within HEIs remit

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Ethical issues

• All interviewees contacted through individual
  associated with death
• Families consent to including cases in research
  obtained
• No contact with families until 6 months after
  deaths
• Interviewees offered bereavement pack and
  followed up after interview
• Anonymity for individuals and institutions
• Study approved by NHS Medical Research Ethics
  Committee and UCLans Ethics Committee

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Findings Prevention 1Mental health needs

• Most case study deaths - young men in early 20s
• 2/3 case studies - diagnosis of mental health
  problem, most emerging while students.
• .he was profoundly depressed but less
  agitated.he felt confused by his relationship
  and felt intense panic before the exams. (Tutor)

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Findings Prevention 2Transition

• ¾ of case study students died in periods of
  transition
• Arrivals and departures
• .had no clue what he wanted to do in his
  life.he was very concerned about leaving
  university, he would have left in the second
  year, he constantly said to me what am I going
  to do? (Student)
• He was packing all his things up to go to
  university the day before he took his own life
  and he just couldnt tell me what was really
  happening to him.he was going through all the
  things that had gone wrong in his life that he
  wanted to put right. (Parent)

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Findings Prevention 3Transition associated
with depression perfectionism

• Mother a perfectionist
• Father Yes, everything had to be right.
• Mother Otherwise it wasnt good enough. . And
  I think that probably was, in a way was his
  problem that he was craving for perfection but
  couldnt get it sometimes. (Parents)

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Findings Prevention 4Disrupted academic
progress

• Disrupted academic histories in half case studies
• Fear of failure
• If he had found a way of leaving university
  comfortably, I think he would have been happy to
  do it. He didnt really want to be there but he
  didnt want to fail it. (Parent)
• .his worst thing was failure, he hated failure,
  and I suppose failing first year at uni was
  obviously a massive trigger (Student)

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Findings Prevention 5Web of problems

• relationship difficulties
• heavy use of alcohol and drugs
• financial problems
• While he was drinking I think it was a sort of
  escape, but then hed have to sort of suffer the
  consequences - hangovers - and it was probably
  the next morning that hed, hed feel really
  depressed because hed feel like he was failing
  himself, because hed started drinking again and
  he wasnt able to crack it. (Student)
• .the girlfriend situation.made him start to say
  to himself are you not any good at
  relationships? Ive got a social problem.
  (Parent)

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Findings Prevention 6Suicide transmission

• Evidence of suicide transmission in 4 of 20 case
  studies
• His death was one of the things and he the
  student included in the research just couldnt
  get rid of that, it kept coming back to him.
  (Student Services)
• when I thought about killing myself, I was
  feeling the most excruciating pain you could
  possibly imagine and I thought the way out of
  this is to kill myself, how will I do it? Oh,
  Ill hang myself, thats what he did. I wanted
  to stop feeling the pain. (Student)

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Findings Prevention 7Stigmatised services

• That bothered him hugely, the fact that he was
  going to be tarred with this brush of mental
  illness that, you know, shouldnt be happening to
  him.but he didnt really seem to want to be
  helped. (Student)
• .he was very sceptical about counselling and
  therapists and he was just trying to outwit them
  rather than actually accepting that they might be
  able to help him. So I think that the sessions
  he had were just a bit of a disaster because of
  that reason. (Student)

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Findings Prevention 8Co-ordination between
services

• Now at the inquest it came out, that hed seen
  a counsellor and it also came out that hed been
  to his GP. saying that he felt suicidal, that he
  was depressed . that was when he was prescribed
  the antidepressant but from what I gather, there
  was no contact between the GP and the counsellor
  at the university, or the GP and anyone else for
  that matter . (Parent)
• The college set it up yes, absolutely, because I
  rang them before she was coming back The college
  set it up yes, absolutely, because I rang them
  before she was coming back and told them in great
  detail what had happened before and I said, Im
  very worried about her, and so they she went
  back on the Sunday and was at a psychiatrist on
  the Monday, theyd already booked an appointment.
  (Parent)

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Findings Prevention 9Housemates managing crises

• Majority of case study group living in private
  rented accommodation at time of death
• .they were very good friends.they took a great
  deal of care of him, they were very concerned for
  his wellbeing and, to some extent, opted to
  change their own path through what they were
  doing, in order to help him out. (Tutor)

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Responses 1Breaking the news

• HEIs taking a proactive approach to breaking the
  news relieves pressure on students
• Balance provision of information with avoidance
  of fanning rumour, speculation
• Manage media

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Responses 1Breaking the news continued

• We already had the housemates . we knew who the
  friends were and I talked to a number of them and
  checked with them who else might need to be told
  . people from the department and people from
  the halls . there was the closed circle and the
  wider circle the student union.athletic union
  . football team .. (Student Services)
• . the university would try to control it and
  bring it through me and the press office and we
  would try to deal with it together, and you know
  Ive worked quite closely with the press office
  . (Student Services)

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Responses 2Key co-ordinating role

• Families and students most likely to feel
  supported when identified person took
  co-ordinating role
• Communication tree helpful
• .we called in the Residents Support Network .
  so we did a kind of telephone tree sort of like
  making sure that all the Deans who were on, on
  site .. were aware and that they were telling
  their coordinators who were telling their
  assistants,. (Student Services)

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Responses 3Students needs

• Welcomed being looked after
• The thing is this isnt the first student ever to
  kill themselves.its happened before for them
  the university, it hasnt happened before for
  us the friends of the student who died, so the
  university should. be a little parent-like
  perhaps about it, and you know at least
  understand and try to help. (Student)
• (I said) Im just going to keep an eye on you .
  I told her what I was doing and .. every once in
  a while I phoned her . by about midway through
  the year she kind of backed off she wanted to
  put it all behind her . (Student Services)

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Responses 4Impact on students academic progress

• Some students friends struggled academically
• Only 2 of those interviewed had friends death
  formally taken into account
• Students not keen to intercalate as wanted to
  continue with their peer group
• Academically not doing so well but not wanting to
  be seen to use the death as an excuse .
  obviously you were struggling .(but) you
  wouldnt want it to be seen that way . so I
  think if theyd approached me . Id tell them
  (Student)

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Responses 5 Housemates in private rented
accommodation

• I didnt feel like I had a choice, I felt like I
  had to deal with it, I had to deal with the
  undertaker . (Student)
• . I went back into his room and it just looked
  exactly the same, I was like oh god . I have to
  sort through this . cos all his stuff was still
  in his room . I was still surrounded by him .
  (Student)

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Responses 6Meeting staff needs in the aftermath

• Staff responses complicated by sense of
  responsibility
• . one of things I was immediately aware of was
  that I had no idea how the family would feel
  towards me, because I knew that they knew he had
  been seeing me . I didnt know whether they
  would feel that I was in some way to blame, or in
  some way derelict in doing what I was supposed to
  have done. (Student Services)
• . my immediate thoughts . where, what did I do
  wrong, what could I have done, is it my fault .
  especially because I was managing the programme
  so I was responsible for .designing and
  inventing the very environment in which it
  happened. (Tutor)

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Responses 6 continuedMeeting staff needs in the
aftermath

• Most staff did not receive formal support from
  HEI
• What would have been really helpful would have
  been if someone had turned around to me and said
  go find yourself someone to talk to . well pay
  for it.(Student Services)

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Responses 7Contact with parents in the aftermath

• Personal contact appreciated
• Parents did not expect HEI to offer them support
  in their own right but valued information on
  where to find it
• Parents wanted to be consulted about issues such
  as amending records, offering coursework,
  memorials etc.
• Wanted HEI to take active approach to learning
  from death

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Responses 7 continuedContact with parents in the
aftermath

• . as soon as I told the university, their
  student counsellor rang me back immediately, and
  gave me a long time to talk about it all and said
  you can ring back anytime, and also asked me if
  I thought there was anything they could do to
  help. (Parent)
• Someone should tell you that there are groups.
  (Parent)

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Recommendations 1HEI Policies

• Mental health strategies have the potential to
  deliver positive messages about mental health
  across the higher education community.
• Policies on sudden death/bereavement are helpful
  should identify chain of communication in the
  event of a sudden death and responsibility for
  particular tasks.

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Recommendations 2Student support services

• University and college support services are
  advised to review their availability to the
  students at key transitional periods in the
  academic year between April and June and from
  late August to October. Students need to be made
  aware of the availability of such services at
  these times.
• Making student support services attractive and
  accessible to students, particularly to young
  men, is recommended - more needs to be known
  about what works.

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Recommendations 3Risk factors

• Students with multiple risk factors, such as
  mental health problems, alcohol and substance
  misuse, relationship problems, perfectionism and
  academic difficulties may be a high risk for
  suicide.
• Student support services need to continue to
  liaise closely with academic services when
  students are in crisis.

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Recommendations 4Proactivity and Inclusivity

• Proactive approach required in the aftermath
• - seeks out those affected by the death
• - extends to students living off-campus
• - extends to the full range of HEI staff
• - management of the media
• Offer those affected by student suicide choices
  - how information is conveyed - commemorating
  the student
• - student records

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Recommendations 5Links with local health services

• HEIs to review their links with local NHS
  services. NHS services should know what support
  is available to students from HEIs and have
  identified point of contact.
• Improved communication between HEIs and local
  health services could ensure that student
  suicides are identified and monitored.

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Acknowledgements

• The researchers would like to thank all family
  members, friends and higher education institution
  staff members who participated in this study. We
  are also grateful to PAPYRUS members and
  trustees, staff and members of SOBS and
  Compassionate Friends, Coroners, Procurators
  Fiscal and their staff, the Projects Advisory
  Group members and many individuals and groups
  within the higher education sector who assisted
  the project.

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• For further info
• Web-site www.rapss.org.uk
• Contact Nicky Stanley
• NStanley_at_uclan.ac.uk
• 01772 893655