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Suicide Prevention, Intervention, and Postvention for Educators


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Title: Suicide Prevention, Intervention, and Postvention for Educators

Suicide Prevention, Intervention, and Postvention
for Educators
  • Southeast Nebraska Suicide Prevention Project
  • and
  • Robin Zagurski, LCSW
  • University of Nebraska Medical Center

Supported by a grant from the Nebraska Healthcare
Cash Fund
Objectives for Educators
  • Know symptoms of depression in adolescents
  • Understand that suicide is a public health
  • Identify ways to protect yourself and others from
  • Identify suicide risk factors
  • Know the red light warning signs for suicide risk
  • Are comfortable offering help to someone at risk
    for suicide
  • Have resources for postvention after a student

Common terms used in this presentation
  • Suicide Intentionally taking ones own life
  • Suicide act or gesture Actions to deliberately
    injure oneself or attempt to injure oneself
    without resulting in death.
  • Suicide Behavior Thoughts, plans, or actions
    which if implemented could result in death
  • Postvention - An intervention after a suicide
    for the students, faculty and friends designed to
    facilitate grieving.

Teen Depression
  • Teenagers, especially young teens, may exhibit
    several symptoms of depression and yet be unaware
    that they are suffering from depression.

Adolescent Depression
  • Extreme sensitivity to rejection or failure
  • Low self-esteem and feelings of guilt
  • Frequent complaints of physical illnesses such as
    headaches and stomachaches
  • Frequent absences from school or poor performance
    in school
  • Threats or attempts to run away from home
  • Major changes in eating or sleeping patterns
  • (American Academy of Child and Adolescent
    Psychiatry, 8/98)

Adolescent Depression
  • Sad, blue, irritable and/or complains that
    nothing is fun anymore
  • Trouble sleeping, low energy, poor appetite and
    trouble concentrating
  • Socially withdrawn or performs more poorly in
  • Can be suicidal
  • National Institute of Mental Health, Treatment
    of Adolescent Depression Study (TADS)

Adolescent Anxiety
  • Excessive worries
  • Worries about school performance
  • Difficulty making friends
  • Isolative
  • Perfectionistic
  • Rigid thinking and behavior patterns
  • Phobias

Suicidal Ideation(Hoberman and Garfinkel 1988)
  • In a study of 229 completed youth suicides
  • 62 had made a suicidal statement
  • 45 had consumed alcohol within 12 hours of
    killing themselves
  • 76 had shown a decline in academic performance
    in the past year

Teen Suicide in the U.S.
  • There are 25 suicide attempts for every
    completion for our country as a whole
  • There are between 100-200 teen attempts before
    completing suicide
  • Girls attempt more often (31)
  • Boys complete suicide more often (41)
  • Every year approximately 2,000 teens suicide
  • Journal of American Academy of Child and
    Adolescent Psychiatry, Practice Parameters, 2002

  • Although suicide is the 11th leading cause of
    death for the overall population, it is the 3rd
    leading cause of death for 15-24 year olds.

Nebraska Teen Suicide Statistics2001
  • In Nebraska
  • 2 children between the ages of 10-14 killed
  • 17 teens between the ages of 15-19 killed
  • 13 of those suicides were by gunshot

Cultural Factors
  • African Americans currently have a lower rate of
    suicide than whites,
  • The suicide rate of African-American adolescent
    and young adult males has been rising rapidly.
  • Native American and Alaskan Native youth have a
    very high rate of suicide.
  • Attempted suicide rates of Hispanic youth are
    greater than those of white and African-American
  • Journal of American Academy of Child and
    Adolescent Psychiatry, Practice Parameters, 2002

Gay and Lesbian Youth
  • There is no evidence gay or lesbian youth commit
    suicide more often than heterosexual teens.
  • However, there is strong evidence that gay,
    lesbian and bisexual youths of both sexes are
    more likely to experience suicidal ideation and
    attempt suicide.

Alcohol and Suicide
  • Alcoholics have a suicide rate 50 times higher
    than the general population
  • Alcohol dependent persons make up 25 of all
  • 18 of alcoholics eventually complete suicide
  • States with the most restrictive policies toward
    alcohol have the lowest suicide rates (Lester,

Self-Injury vs. Suicide
  • Self-injury is an attempt to alter ones mood by
    inflicting physical harm on oneself
  • Carving
  • Burning
  • Scratching
  • Branding
  • Hitting

Protection Against SuicideGreen LightGood to Go!
  • Getting help for mental, physical and substance
    abuse disorders - Especially depression
  • Restricted access to highly lethal methods of
    suicide especially firearms
  • An established relationship with a doctor,
    clergy, teacher, counselor or other professional
    who can help
  • Connectedness to community, family, friends
  • Learned skills in problem solving and non-violent
    conflict resolution
  • Cultural/religious beliefs that discourage

Suicide Risk FactorsYellow Light Proceed with
  • Mental disorders-particularly mood or eating
  • Substance abuse disorders
  • Family history of suicide
  • Hopelessness
  • Impulsive and /or aggressive tendencies
  • Barriers to accessing mental health treatment
  • Divorced parents or poor family communication

Suicide Risk FactorsYellow Light Proceed with
  • Relational, social, work, or financial loss
  • Physical illness
  • Previous suicide act
  • Easy access to lethal methods, especially guns
  • Age, Culture, Lack of connectedness
  • Exposure to sensational media reports of suicide

Suicide Warning SignsRed Light Stop Get Help
  • Talking, reading, or writing about suicide/death.
  • Talking about feeling worthless or helpless.
  • Saying Im going to kill myself, I wish I was
    dead, or I shouldnt have been born.
  • Visiting or calling people to say goodbye.
  • Giving things away or returning borrowed items.
  • Self destructive or reckless behavior.
  • Significant change in behavior
  • Running away

Suicide Warning SignsRed Light Stop Get Help
  • Hopelessness typical hopeless statements
  • Theres no point in going on
  • I cant take it anymore
  • I have nothing left to live for
  • I cant stop the pain
  • I cant live without _______
  • My life keeps getting worse and worse
  • I might as well kill myself

Why should Schools be Involved?
  • Children come into contact with more potential
    rescuers in the schools than in the community
  • Childrens problems are often more apparent in
    the school than in the home
  • Children from divorced and/or dysfunctional
    families are less likely to get help at home
  • Guetzloe, 1991

School Specific Signs of Distress
  • Any sudden or dramatic change should be taken
    seriously, such as
  • An overall decline in grades
  • Decrease in effort
  • Misconduct in the classroom
  • Unexplained or repeated absence or truancy

Who Should Intervene?
  • Not everyone who works with teenagers should
    work with a suicidal teenager.
  • Know your limitations
  • Get someone else to help if you
  • Are a recent suicide survivor
  • Are experiencing suicidal thoughts yourself
  • Are experiencing significant stress in your own
  • If you have negative personal feelings about the

What do Educators Need to Know?
  • There is no confidentiality when a child is
    talking about suicide
  • Act immediately. Do not wait until class is over
    or until the end of the day.
  • Take action even if you are not sure
  • http//

What action?
  • Immediately contact the school counselor/social
    worker or school administrator
  • The school counselor/social worker or school
    administrator will then contact the students
    parents or guardian
  • Keep the student under supervision at all times
    until someone else takes over.

What Can YOU Say?
  • Im glad you told me, I want to help.
  • Im glad you told me, and I am going to find
    someone to help you.
  • I will stay with you until help arrives.

What NOT to Say
  • Its just a phase
  • Youll snap out of it
  • Stop being so selfish
  • Youre just trying to get attention
  • Get over it

What NOT to do.
  • Dont let them bargain you out of getting them
  • Be careful with no-suicide contracts
  • Dont make coercive statements, such as unless
    you promise not to hurt yourself, youll have to
    go to the hospital

Postvention after a Suicide
  • Goals
  • Return the school to its pre-crisis milieu
  • Identify, refer, and/or assist students who may
    be at risk for depression, suicide, and other
    psychological problems due to their exposure and
    relationship to the victim
  • Help students begin a healthy grieving process
  • Kerr, Brent and McKain, 1997

Guidelines for postvention with students
  • Explain that it is normal to feel emotions such
    as shock, fear, sadness, guilt or anger.
  • Let students know there is no right way to feel
    after a suicide.
  • Help to clarify facts about the suicide. Ask
    students to tell you what they have heard.
    Correct errors and rumors if necessary.

Postvention Guidelines (cont)
  • Stress that no one is to blame for the suicide.
    The victim alone made the decision to commit
  • Focus on recovery of the survivors and alternate
    methods of dealing with problems.
  • Rehearse possible condolence messages to the
    family. Kerr, Brent, McKain 1997

  • Emphasize that help is available to all students,
    not just to those students who are feeling
  • Make sure students know where to go to get help
    for themselves or for a friend who is depressed
    or suicidal.
  • Kerr, Brent, McKain 1997

What NOT to do after a suicide
  • Do not put in a permanent memorial for the person
    who killed themselves. (i.e., no tree planting,
    plaques, etc.)
  • Do not glorify the death by having large memorial
    services with lots of fanfare.

The Southeast Nebraska Suicide Prevention Project
  • Lead Agency
  • Blue Valley Mental Health Center
  • Project Partners
  • Bryan/LGH Medical Center
  • Community Mental Health Center of Lancaster

  • The Yellow Ribbon Program
  • The National Suicide Hopeline
  • 1-800-SUICIDE
  • BryanLGH Counseling Center
  • 481-5991
  • BryanLGH 24-hour Mental Health Assistance Nurse
  • 475-1011 OR 1-800-742-7845
  • AFSP Teen Suicide Prevention Kit
  • 1-888-333-AFSP
  • American Association of Suicidology

Postvention Guideline Resources
  • Services for Teens at Risk (STAR)
  • http//
  • Postvention Standards Guidelines A guide for a
    schools response in the aftermath of a sudden
    death. Kerr, Mary Margaret, Ed.D., Brent, David
    A., M.D., McKain, Brian, M.S.N.. Star Center
    Publications, 3rd Edition.

School Curriculum Caveat
  • According to the American Academy of Child
  • Teaching entire courses on suicide to groups of
    students should be discouraged as it appears to
    activate suicidal ideation in disturbed
  • Courses on teaching problem solving, social
    skills, conflict resolution, and reporting skills
    are helpful in preventing suicide in teens.

School Curriculum Suggestions
  • The National Education Association suggests
  • Dont sensationalize or normalize suicide
  • General education programs that teach the facts,
    warning signs, and risk factors associated with
    suicide do impart knowledge.
  • Treat suicide prevention within a broader mental
    health focusincluding work on enhancing coping
    skills and dealing with risk factor issues like
    substance abuse.

Steps parents can take
  • Get your child help (medical or mental health
  • Support your child (listen, avoid undue
    criticism, remain connected)
  • Become informed (library, local support group,
  • Restrict access to firearms
  • Carol Watkins, M.D.

Steps teens can take
  • Take your friends actions seriously
  • Encourage your friend to seek professional help,
    accompany if necessary
  • Talk to an adult you trust. Dont be alone in
    helping your friend. Carol Watkins, M.D.
  • 4. Dont keep the secret.