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Title: College Students and Suicide Prevention – Administrators and Staff


1
College Students and Suicide Prevention
Administrators and Staff
  • Ellen J. Anderson, Ph.D., SPCC

2
College Student Suicide
  • Suicide is the second leading cause of death for
    college students
  • The number one cause of suicide for college
    student suicides (and all suicides) is untreated
    depression

3
Despair At A Young Age
  • Unlike most disabling physical diseases, mental
    illness begins very early in life. Half of all
    lifetime cases begin by age 14 three quarters
    have begun by age 24. Thus, mental disorders are
    really the chronic diseases of the young,
    (National Institute of Mental Health)
  • Anxiety disorders often begin in late childhood
  • Mood disorders in late adolescence
  • Substance abuse in the early 20s
  • Unlike heart disease or most cancers, young
    people with mental disorders suffer disability
    when they are in the prime of life, when they
    would normally be the most productive

4
Despair At A Young Age
  • Many young people who come to college have not
    yet been diagnosed with Depression,
    Schizophrenia, or Bi-Polar Disorder
  • We are seeing an increase in suicidal ideation
    and behavior on campus as more people with severe
    mental illness attend college
  • Improved treatment has allowed many young people
    to continue a normal life despite the development
    of severe mental illnesses

5
Despair At A Young Age
  • In general, non-college young adults complete
    suicide at about twice the rate as college
    students
  • Foreign students may have a higher risk for
    suicide
  • Suicide is not more frequent in any of the four
    years of college, but it does occur more often in
    students who take more than four years to earn
    their degrees

6
High Levels Of Stress
  • Going to college can be a difficult transition
    period in which students may experience high
    levels of stress, which can lead to Clinical
    Depression
  • Many college students also use higher levels of
    alcohol and drugs than at earlier times in their
    lives, increasing the risk of suicidal ideation
  • A hallmark of diagnosis for clinical depression
    is the presence of suicidal thinking
  • Yet our lack of knowledge about this illness
    means that we dont seek help, and our friends
    and family dont push us to get help

7
Unwilling To Seek Help
  • Stigma about treatment means that very few people
    with suicidal ideation actually seek treatment
  • Additionally, a survey indicates that one in five
    college students believe that their depression
    level is higher than it should be, yet only 20
    say they would go to the campus counseling center
  • Those whose symptoms improve when they activate a
    suicide plan may be especially resistant to
    seeking help
  • Nearly half of suicidal students present for some
    medical treatment in the months before completing
    suicide although they may not acknowledge
    suicidal thoughts

8
Awareness
  • Teachers, coaches, and residence hall counselors
    should focus not only on disruptive students, but
    also on those who are quietly withdrawn or whose
    dormitory discussions or classroom essays
    disclose hopelessness and suicidal thinking
  • Training in awareness about depression and
    suicidal thinking is important for all staff
  • Policies should be in place to discover students
    with suicidal ideation and help them to recover

9
How common is suicide among teenagers and young
adults?
  • Suicide is the 3rd largest killer of young people
    between the ages of 10 and 25, and the 2nd
    largest killer of young adults
  • Suicidal ideation is admitted by about 25 of
    adolescents at some time during high school
  • Suicide attempts are more frequent among the
    young than the old, although completions are less
    likely
  • About 4,000 young people die from suicide every
    year in the US
  • Teen suicide tripled between 1950 and 1980, but
    has dropped somewhat in the past 25 years
  • Around the world, adolescent suicide declined in
    industrialized nations with the increase in use
    of anti-depressant medication, despite fears that
    meds will increase suicidal behavior in teens

10
What Is Mental Illness?
  • Prior to our understanding of illness caused by
    bacteria, most people thought of any illness as a
    spiritual failure or demon possession
  • Contamination meant spiritual contamination
  • People were frightened to be near someone with
    odd behavior for fear of being contaminated

10
Gatekeeper Training- Dr. Ellen Anderson
11
What Is Mental Illness?
  • What do we say about someone who is odd?
  • Looney, batty, nuts, crazy, wacko, lunatic,
    insane, fruitcake, psycho, not all there, bats in
    the belfry, gonzo, bonkers, wackadoo, whack job
  • Why would anyone admit to having a mental
    illness?
  • So much stigma makes it very difficult for people
    to seek help or even acknowledge a problem

11
Gatekeeper Training- Dr. Ellen Anderson
12
What Is Mental Illness?
  • We know that illnesses like epilepsy, Parkinson's
    and Alzheimers are physical illness in the brain
  • Somehow, clinical depression, anxiety, Bi-Polar
    Disorder and Schizophrenia are not considered
    physical illnesses requiring treatment
  • We confuse brain with mind
  • Talking about suicide is taboo

12
Gatekeeper Training- Dr. Ellen Anderson
13
Is Suicide Really a Problem?
  • 87 people complete suicide every day
  • 32,466 people in 2005 in the US
  • Over 1,000,000 suicides worldwide (reported)
  • This data refers to completed suicides that are
    documented by medical examiners it is estimated
    that 2-3 times as many actually complete suicide
  • (Surgeon Generals Report on Suicide, 1999)

13
Gatekeeper Training- Dr. Ellen Anderson
14
The Gender Issue
  • Women perceived as being at higher risk than men
  • Women do make attempts 4 x as often as men
  • But - Men complete suicide 4 x as often as women
  • Womens risk rises until midlife, then decreases
  • Mens risk, always higher than womens, continues
    to rise until end of life
  • Are women more likely to seek help? Talk about
    feelings? Have a safety network of friends?
  • Do men suffer from depression silently?

14
Gatekeeper Training- Dr. Ellen Anderson
15
What Factors Put Someone At Risk For Suicide?
  • Biological, physical, social, psychological or
    spiritual factors may increase risk-for example
  • A family history of suicide increases risk by 6
    times
  • Access to firearms people who use firearms in
    their suicide attempt are more likely to die
  • Social Isolation people may be rejected or
    bullied because they are weird, because of
    sexual orientation, or because they are getting
    older and have lost their social network
  • (Goleman, 1997)

15
Gatekeeper Training- Dr. Ellen Anderson
16
  • A significant loss by death, separation, divorce,
    moving, or breaking up with a boyfriend or
    girlfriend can be a trigger
  • The 2nd biggest risk factor - having an alcohol
    or drug problem
  • Many with alcohol and drug problems are
    clinically depressed, and are self-medicating for
    their pain
  • (Surgeon Generals call to Action, 1999)

16
Gatekeeper Training- Dr. Ellen Anderson
17
  • The biggest risk factor for suicide completion?
  • Having a Depressive Illness
  • Someone with clinical depression often feels
    helpless to solve his or her problems, leading to
    hopelessness a strong predictor of suicide risk
  • At some point in this chronic illness, suicide
    seems like the only way out of the pain and
    suffering
  • Many Mental health diagnoses have a component of
    depression anxiety, PTSD, Bi-Polar, etc
  • 90 of suicide completers have a depressive
    illness
  • (Lester, 1998, Surgeon General, 1999)

17
Gatekeeper Training- Dr. Ellen Anderson
18
Depression Is An Illness
  • Our current cultural view of suicide is wrong -
    invalidated by current understanding of brain
    chemistry and its interaction with stress,
    trauma and genetics on mood and behavior
  • Suicidal thinking is a severe symptom of the way
    depression is altering the brain causing
    changes in thinking, mood and body regulation
  • Suicide has been viewed for centuries as
  • a moral failing, a spiritual weakness, a mortal
    sin
  • an inability to cope with life
  • the cowards way out
  • A character flaw
  • This view must be replaced by more current
    understanding of brain disorders as treatable,
    physical illnesses
    (Anderson, 1999)

19
  • The research evidence is overwhelming -
    depression is far more than a sad mood. It
    includes
  • Body Regulation Problems
  • Weight gain/loss
  • Sleep problems
  • Sense of tiredness, exhaustion
  • Mood Regulation Problems
  • Sad or angry mood
  • Loss of interest in pleasurable things, lack of
    motivation
  • Irritability
  • Thinking and Memory Problems
  • Confusion, poor concentration, poor memory,
    trouble making decisions
  • Negative thinking
  • Withdrawal from friends and family
  • Often, suicidal thoughts
  • (DSMIVR, 2002)

20
  • 20 years of brain research teaches that these
    symptoms are the behavioral result of
  • Changes in the physical structure of the brain
  • Damage to brain cells in the hippocampus,
    amygdala and limbic system
  • Depressed people suffer from a physical illness
    what we might consider faulty wiring
  • (Braun, 2000 Surgeon Generals
    Call To Action, 1999, Stoff Mann, 1997, The
    Neurobiology of Suicide)

20
Gatekeeper Training- Dr. Ellen Anderson
21
Faulty Wiring?
  • Literally, damage to certain nerve cells in our
    brains - the result of too many stress hormones
  • Cortisol
  • Adrenaline
  • Testosterone hormones activated by our
    Autonomic Nervous System to protect us in times
    of danger
  • Chronic stress causes changes in the ANS, so that
    high levels of activation occur with very little
    stimulus
  • Constant activation in the ANS causes changes in
    muscle tension, imbalances in blood flow patterns
    - leads to asthma, IBS and depression, increased
    risk for death from heart disease
  • (Goleman, 1997, Braun, 1999)

22
Faulty Wiring?
  • Every time something upsets us it causes the ANS
    to activate stresses accumulate and keep us in
    a state of high arousal stress hormones build
    up
  • People with genetic predispositions, placed in a
    highly stressful environment will experience
    damage to brain cells from stress hormones
  • As damage occurs, thinking changes in the
    predictable ways identified in our list of 10
    criteria (Goleman, 1997 Braun, 1999)

23
One of Many Neurons
  • Neurons are special cells that make up the brain
    and their united, networked action is what causes
    us to think, feel, and act
  • Neurons must connect to one another (through
    dendrites and axons)
  • Stress hormones damage dendrites and axons,
    causing them to shrink away from other
    connectors
  • As fewer and fewer connections are made, more and
    more symptoms of depression appear

23
Gatekeeper Training- Dr. Ellen Anderson
24
How Can We Stop Brain Damage?
  • As damage occurs, thinking changes in the
    predictable ways identified in our list of 10
    criteria
  • Four things can reduce this brain damage
  • Stress reducing mental exercises - meditation
  • Exercise
  • Antidepressant medication
  • Cognitive/Behavioral Psychotherapy

25
  • Many cultures have developed stress reduction
    rituals/mental exercises Yoga, Tai Chi, Qi
    Jong, meditation, prayer these millennia old
    methods work well to reduce stress hormone
    production
  • Exercise can help burn off high stress hormone
    levels and even reduce production
  • Antidepressants can counter the effects of stress
    hormones
  • We know now that antidepressants stimulate genes
    within the neurons (turn on growth genes) which
    encourage the growth of new dendrites
  • New dendrites reconnect neurons and symptoms are
    reduced
  • It can take longer than six weeks for the brain
    to repair itself enough that people feel better
  • (Braun, 1999)

26
How Does Therapy Help?
  • Medications may improve brain function, but do
    not change how we interpret stress
  • Cognitive or interpersonal therapy helps people
    change the (negative) patterns of thinking that
    lead to depressed and suicidal thoughts
  • Changing our inaccurate beliefs and thought
    patterns alters our response to stress we are
    not as reactive or as affected by stress at the
    physical level
  • Research shows that cognitive therapy is as
    effective as medication in reducing depression
    and suicidal thinking (Lester, 2004)

27
How Does Therapy Help?
  • The Talking Cure as Freud originally called it
    turns out to have a scientific basis for success
  • Daniel Goleman, Daniel Siegal, Antonio DAmasio
    and others are explaining how social interaction
    with others physically alters our neuronal paths,
    allowing different ways of thinking to change the
    chemical, electrical and thought pattern flow in
    our brains
  • We know that people raised in highly abusive
    homes have visibly different brains than people
    from normal homes, as seen on MRIs and CAT scans
  • We also know that healing relationships, changed
    perspectives (reframing) and altered self-beliefs
    change how people react to stress, and what they
    react to

28
Possible Sources Of Depression
  • Genetic a predisposition to this problem may be
    present, and depressive diseases run in families
  • Predisposing factors Childhood traumas, car
    accidents, brain injuries, abuse and domestic
    violence, poor parenting, growing up in an
    alcoholic home, chemotherapy
  • Immediate triggers violent attack, illness,
    sudden loss or grief, loss of a relationship, any
    severe shock to the system
  • (Anderson, 1999, Berman Jobes, 1994, Lester,
    1998)

28
Gatekeeper Training- Dr. Ellen Anderson
29
What Happens If We DontTreat Depression?
  • Significant risk of increased alcohol and drug
    use
  • Significant relationship problems
  • Lost work days, lost productivity (up to 40
    billion a year)
  • High risk for suicidal thoughts, attempts, and
    possibly death
  • (Surgeon Generals Call To Action, 1999)

29
Gatekeeper Training- Dr. Ellen Anderson
30
Can Suicide Be Predicted?
  • No
  • That said, there are Practice Guideline standards
    for assessment that should be followed
  • Be aware of the Impulsive nature of most suicides
  • Responsibility for knowledge of risk factors for
    suicide
  • Dangers of misusing risk assessment scales-may
    not account for todays danger

31
College Mental Health Professionals
  • What are ethical obligations for college mental
    health professionals?
  • As with any mental health professional, a duty to
    warn and a responsibility to students with
    suicidal ideation to treat and keep safe
  • Responsible to assess risk and help students
    manage symptoms,
  • Responsible to seek medical assistance and
    hospitalization as needed
  • Need for a fully documented risk assessment
  • Dangers of abandonment, negligent referral, and
    fragmented care
  • Maintain standards of care

32
What Are "Best Practices" In Staff Training And
Educational Programming
  • The United States Air Force model
  • Develop a campus-wide commitment to suicide
    prevention
  • Reducing stigma against seeking professional help
  • Depression screening programs and online
    resources Jed Foundation, American Foundation
    For Suicide Prevention

33
What Are My Responsibilities?
  • We should not be looking at student suicide
    primarily from a risk-management perspective
  • College administrator responses to students
    become defined by the law and not through primary
    responsibility as educators
  • As educators, we have to take some risks. That
    means working harder to keep students at risk of
    suicide enrolled, working with them, giving them
    the help they need, and not finding faster and
    more creative ways to remove them. (Gary
    Pavela, 2006, The Chrone)

34
A Protective Environment
  • Mandatory-removal policies carry legal risks of
    their own - ADA
  • Office for Civil Rights within the U.S.
    Department of Education has been called upon to
    issue letter rulings pertaining to these policies
    students with documented mental health
    diagnoses may win a lawsuit
  • The risk of liability for suicides is low most
    cases focus on high risk immediate suicidality
  • College administrators, may err on the side of
    under-reaction, in terms of notifying parents, in
    terms of hospitalization
  • Decisions in some recent cases do not define the
    law nationally and do not mean your proper
    response as an administrator is to find a quick
    way to get rid of the student
  • What the cases would point to is that you must
    react promptly and appropriately to a student who
    is manifesting signs of imminent risk of suicide
    (Pavela, 2006)

35
Parental Notification
  • Should colleges notify parents of students at
    risk of suicide?
  • Previously, a strong bias not to notify parents
    about problems a student was having
  • In recent years a shift toward more parental
    notification
  • FERPA Family Educational Rights and Privacy Act
    amended able to notify parents in certain
    alcohol incidents
  • Who should notify parents and under what
    conditions?
  • Mental-health professionals will have a legal and
    ethical obligation to breach confidentiality in
    an emergency, when a person is at imminent risk
    of harming themselves
  • Parents would have to be notified by the
    hospital. When students enroll, it should be part
    of their file Who do you want notified in case
    of emergency?

36
Parental Notification
  • My role of an administrator
  • Administrators have more latitude than
    mental-health professionals to notify parents
  • Err on the side of treating suicidal statements
    as a genuine suicide threat or gesture,
  • Arrange for immediate evaluation of that student,
  • Ask the student about needing to involve the
    parents immediately,
  • Listen to arguments about why that wouldn't work,
    and I would
  • Talk to a mental-health professional.
  • Once there is a suicide threat or gesture -
    notify parents, even when it isn't a full-blown
    emergency

37
Should Colleges Withdraw Students Who Threaten Or
Attempt Suicide?
  • Rate of young-adult suicide for people going to
    college is about one-half of the rate for young
    adults who are not going to college
  • Campus environments, human connection, and
    limited access to firearms are protective
  • College campuses do a good job of limiting
    firearms, the most dangerous choice of a suicide
    weapon
  • Sending kids home means taking them out of a
    protective environment and putting them where
    they may be more likely to hurt themselves
  • policies can use the threat of removal as
    "leverage" to get students help they need.
  • Use the administrative process as a lever to get
    the student help
  • We are a community that can't tolerate violence,
    including violence to self, and we have a
    mechanism to help you, and if not, we can remove
    you
  • Both are using discipline as a threat, but one is
    carrying through immediately, and the other is
    doing everything possible not to use it.

38
Empowering Students To Help Prevent Suicides
Among Peers
  • Often peers know about potentially suicidal and
    depressed behavior and comments
  • Increase discussion with students about the
    responsibility of friendship
  • A higher loyalty is to save a person's life, not
    keep a persons secret
  • Friends don't let depressed students handle their
    problem alone, and they get help for that
    student, even if they have to break
    confidentiality
  • Teach when to get help and where to get it this
    goes beyond the ability of friendship to manage

39
Help Faculty React Appropriately
  • Training is needed so that faculty will not
    under-react to suicidal references
  • Training to understand what depression is and how
    it can lead to suicide
  • Realizing that relationship and support is not
    enough we dont simply offer kindness when
    someone is having a heart attack

40
Mentoring and Connection
  • One of the triggering factors to depression is
    isolation, the feeling of not being a part of a
    community
  • College students still need adult support and
    someone to talk with
  • Faculty and students alike need training in these
    issues, but stigma makes it difficult for people
    to talk about
  • Try a stress-management seminar
  • Talk about relationship issues, as many suicidal
    thoughts come up as a response to relationship
    loss
  • Dont be afraid to bring up suicide in any
    appropriate discussion setting

41
After A Suicide
  • Schools should prepare postvention plans in case
    a suicide does occur on the campus
  • The plans should focus on outreach to survivors
    and on preventing suicide contagion by managing
    the information that is presented to the press
    and public
  • Opportunities to talk should be made available to
    students and staff
  • Connections should be maintained with other
    students who are known to have suicidal thoughts,
    and on friends of the person who died

42
Jed Foundation Prevention Model
43
  • If one cannot state a matter clearly enough so
    that even an intelligent twelve-year-old can
    understand it, one should remain within the
    cloistered walls of the university and laboratory
    until one gets a better grasp of one's subject
    matter
  • Margaret Mead

44
A Brief Bibliography
  • American Foundation for Suicide Prevention (AFSP)
    has launched the College Screening Project - a
    pilot program aimed at identifying college
    students at risk for suicide and encouraging them
    to get help they need
  • Anderson, E. The Personal and Professional
    Impact of Client Suicide on Mental Health
    Professionals. Unpublished Doctoral dissertation,
    U. of Toledo, 1999
  • Berman, A. L. Jobes, D. A. (1996) Adolescent
    Suicide Assessment and Intervention.
  • Blumenthal, S.J. Kupfer, D.J. (Eds) (1990).
    Suicide Over the Life Cycle Risk Factors,
    Assessment, and Treatment of Suicidal Patients.
    American Psychiatric Press.
  • Jacobs, D., Ed. (1999). The Harvard Medical
    School Guide to Suicide Assessment and
    Interventions. Jossey-Bass.

45
  • Jamison, K.R., (1999). Night Falls Fast
    Understanding Suicide. Alfred Knopf 
  • Lake, P. (2002). The Emerging Crisis of College
    Student Suicide Law and Policy Responses to
    Serious Forms of Self-Inflicted InjuryStetson
    Law Review, Vol. 32, No. 1, 2002
  • Lester, D. (1998). Making Sense of Suicide An
    In-Depth Look at Why People Kill Themselves.
    American Psychiatric Press
  • Oregon Health Department, Prevention. Notes on
    Depression and Suicide ttp//www.dhs.state.or.us/
    publickhealth/ipe/depression/notes.cfm
  • Putukian, M. Wilfert, M, 2004. Student Athletes
    Also Face Dangers From Depression
    http//www.ncaa.org/news/2004/20040412/active/4108
    n32.html
  • Pavela, G. (2006) College Student Suicide Legal
    Issues
  • Presidents New Freedom Council on Mental Health,
    2003
  • Quinnett, P.G. (2000). Counseling Suicidal
    People. QPR Institute, Spokane, WA
  • Schneidman, E.S. (1996). The Suicidal Mind.
    Oxford University Press.
  • Schwartz AJ and Whitaker LC. Suicide among
    college students Assessment, treatment and
    intervention. In SJ Blumenthal DJ Kupfer (Eds)
    Suicide over the life cycle Risk factors,
    assessment, and treatment of suicidal patients.
    (pp. 303-340). Washington DC American
    Psychiatric Press, 1990.

46
  • Signs of Depression in Youth. Oregon State Dept.
    of Health. http//www.dhs.state.or.us/publichealth
    /
  • ipe/depression/signs.cfm
  • Stoff, D.M. Mann, J.J. (Eds.), (1997). The
    Neurobiology of Suicide. American Academy of
    Science
  • Styron, W. (1992). Darkness Visible. Vintage
    Books
  •  
  • Surgeon Generals Call to Action (1999).
    Department of Health and Human Services, U.S.
    Public Health Service.
  •  
  • Tang, T.Z. De Rubeis, R.J. ((1999). Sudden
    Gains and critical sessions in cognitive-behaviora
    l therapy for depression. Journal of Consulting
    and Clinical Psychology 67 894-904.
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