Some Secrets SHOULD be Shared

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Some Secrets SHOULD be Shared
It Takes a Village Involving School Staff and
Parents in Suicide Prevention Candice Porter,
MSW, LICSW Executive Director Screening for
Mental Health, Inc.
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What is Screening for Mental Health, Inc.

• SMH is
• a national non-profit organization whose mission
  is to provide innovative mental health and
  substance abuse resources, linking those in need
  to quality treatment options.
• The SOS Signs of Suicide Prevention Program is
• an award-winning, evidence-based educational and
  screening tool used in middle and high schools
  across the country.

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Youth Programs at SMH

• SOS Signs of Suicide Prevention Program
• High School Program
• Middle School Program
• SOS Signs of Suicide Booster Program
• Signs of Self-Injury Prevention Program

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What we will cover today

• Youth suicide
• Signs symptoms
• Risk factors other definitions
• What can schools do? Implementing an
  evidence-based, universal prevention program
• Reaching out to trusted adults in your community
• Suicide prevention and risk management
• Talking points
• Question and answer

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Prevalence of Suicide Among Youth

• 3rd leading cause of death among youth ages 15-24
  (CDC, 2011)
• In 2011, 4,630 people between the ages of 15 and
  24 completed suicide.
• 12.5 of total suicides that year.
• But STILL.adolescent suicidal behavior is deemed
  underreported

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By the Numbers

• 2013 Youth Risk Behavior Survey found that
• 29.9 felt so sad or hopeless for 2 weeks that
  they stopped doing some usual activity.
• 17.0 seriously considered attempting suicide.
• 13.6 made a suicide plan.
• 8.0 attempted suicide.
• 2.7 of those who made an attempt required
  medical attention
• Find the data for your city/state
• http//www.cdc.gov/HealthyYouth/yrbs/index.htm

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Wisconsin Student Health Survey
Behaviors that Contribute to Unintentional Injuries and Violence WI Students US Students MA Students Are At
Seriously considered attempting suicide (During the 12 months before the survey.) 13.2 15.8 Less Risk
Attempted suicide (One or more times during the 12 months before the survey.) 6.0 7.8 Equal Risk
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Risk Factors

• A risk factor is any personal trait or
  environmental quality that is associated with
  suicide.
• Risk factors ? causes.
• Examples
• Behavioral Health (depressive disorders, NSSI,
  substance abuse)
• Personal Characteristics (hopelessness, ?
  self-esteem, social isolation, poor
  problem-solving)
• Adverse Life Circumstances (interpersonal
  difficulties, bullying, hx abuse, exposure to
  peer suicide)
• Family Characteristics (family hx suicide,
  parental divorce, family hx mental health
  disorders)
• Environmental (exposure to stigma (including
  discrimination based on sexual orientation),
  access to lethal means, limited access to mental
  health care, lack of acceptance)

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Risk Factors for Suicide

• Mental illness
• The strongest risk factors for suicide in youth
• depression
• substance abuse
• previous attempts (NAMI, 2003)
• Over 90...
• of people who die by suicide have a least one
  major psychiatric disorder (Gould et al., 2003)
• Alarmingly, 80...
• of youth with mental illness are not receiving
  services (Kataoka, et al 2002).

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Alcohol and Suicidal Behavior in Teens

• Alcohol use, drinking while down, and heavy
  episodic drinking are strongly associated with
  suicide among adolescents.
• Relationship of drinking to unplanned suicides
• ? disinhibition and impulsivity
• ? aggression and negative affectivity
• ? cognitive constriction ? restricted production
  of alternative coping strategies
• Drinking alcohol while down more than a 75
  increase in risk
• Alternative avenue for identification and early
  intervention.
• (Schilling, et al. 2009)

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Suicide Warning Signs

• A warning sign is an indication that an
  individual may be experiencing depression or
  thoughts of suicide.
• Most individuals give warning signs or signals of
  their intentions.
• Seek Immediate Help
• Threat to kill themselves, actively seeking
  means, talking/writing about death
• Other Warning Signs to Take Seriously
• Risky behavior, recklessness
• ? substance use
• ? interest in usual activities
• Withdrawal
• Stay aware of changes in your students
• in their affect, behavior, appearance,
  attendance, etc.

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Protective Factors

• Protective factors are personal traits or
  environmental qualities that can reduce the risk
  of suicidal behavior.
• Protective factors dont provide immunity,
• but help reduce risk.
• Examples
• Individual Characteristics (adaptable
  temperament,
• coping skills, self-esteem, spiritual faith)
• Family/Other Support (connectedness, social
  support)
• School (positive experience, connectedness, sense
  of respect)
• Mental Health and Healthcare (access to care,
  support through medical and mental health
  relationships)
• Access to Means (restricted access to
  firearms/medications/alcohol, safety barriers for
  bridges)

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Precipitating Event

• A precipitating event is a recent life event that
  serves as a trigger, moving an individual from
  thinking about suicide to attempting to take his
  or her own life.
• NOT causes
• No single event causes suicidality other risk
  factors are typically present.
• Examples
• breakup
• bullying incident
• sudden death of a loved one
• trouble at school

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Suicide A Multi-Factorial Event
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What Can Schools Do?

• School systems are not responsible for meeting
  every need of their students. But when the need
  directly affects learning, the school must meet
  the challenge.
• (Carnegie Task Force on Education)
• Barriers to the mission of education
• Take responsibility
• minimize student alienation despair
• Promote healthy development protective buffers
• Center for Mental Health in Schools at UCLA
  (http//smhp.psych.ucla.edu)

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SOS Signs of Suicide Program Goals

• Decrease suicide and attempts by increasing
  knowledge and adaptive attitudes about depression
• Encourage individual help-seeking and
  help-seeking on behalf of a friend
• Reduce stigma mental illness, like physical
  illness, requires treatment
• Engage parents and school staff as partners in
  prevention through education
• Encourage schools to develop community-based
  partnerships

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SOS Signs of Suicide Student Goals

• Help youth understand that depression is a
  treatable illness
• Educate youth that suicide is not a normal
  response to stress, but a preventable tragedy
  that is often a result of untreated depression
• Inform youth of the risk associated with alcohol
  use to cope with feelings
• Increase help-seeking by providing students with
  specific action steps ACT
• Encourage students and their parents to engage in
  discussion about these issues

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Universal Prevention

•  

• Universal prevention strategies are designed to
  reach the entire population, without regard to
  individual risk factors and are intended to reach
  a very large audience. The program is provided to
  everyone in the population, such as a school or
  grade, with a focus on risk reduction and health
  promotion.
• Reach a broad range of adolescents
• At-risk/sub-clinical/clinical symptoms
• Reduces stigmatization
• Promotes learning and resiliency in all students
• Overrides implementer assumptions

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ACT
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SOS Program Components

• What comes in the program?
• Implementation Guide
• Educational DVD Discussion Guide
• Screening Tools and Student Response Cards
• High School Student Newsletter / Middle School
  Student Parent Newsletters
• Customizable Wallet Cards/ ACT stickers / Posters
• Educational Materials for Staff, Students, and
  Parents
• Postvention Guide
• Gatekeeper Training Tools Training Trusted
  Adults DVD and Plan, Prepare, Prevent online
  training module
• Life Teammates Packet for Coaches

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Youth Programs at SMH

• SOS Signs of Suicide Prevention Program
• High School Program 395
• Middle School Program 395
• Combination Program 655
• SOS Signs of Suicide Second Act Program 200
• Signs of Self-Injury Prevention Program 175

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Gatekeeper Training

• Gatekeeper training involves educating adults who
  regularly interact with youth to recognize
  warning signs for suicide and know how to respond
  appropriately to at-risk youth.
• A gatekeeper should ultimately be able to provide
  a link, or open the gate, between a young person
  and a mental health professional.

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Why Gatekeeper Training?

• Teaches additional skills, including how to
• reduce a persons suicide risk by talking with
  them
• keep someone safe until additional help can be
  found
• facilitate referrals
• Creates more community members prepared to help
• Trains adults to effectively respond if
  approached for help by a youth
• Increases participation and investment of
  community in youth suicide prevention
• Clarifies myths and facts about youth mental
  health and suicide

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Gatekeeper Module
To launch the SOS online gatekeeper module,
visit www.MentalHealthScreening.org/Gatekeeper
1.5 free contact hours for school social workers,
counselors, psychologists, and nurses
(Certificate of Completion available for all
learners) CEUs for social workers sponsored
by ACSSW
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Training Trusted Adults SOS Gatekeeper Video
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Sample Qs from the Discussion Guide

• What are some of the risk factors and warning
  signs in the video that stuck out for you?
• What are some protective factors you might find
  in your students?
• The professionals discussed confidentiality and
  Melissa in Elyssas story said, Its ok to
  tell. What are some steps to take if a student
  discloses the need for help?
• What qualities do you think make you a trusted
  adult?

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Preparing for Your Staff Meeting/Parent Night

• Review your schools crisis response protocol
• Take SOS online gatekeeper training module
• Familiarize yourself with youth depression and
  suicidality
• Plan for specific program implementation
• Work with your administration
• Establish whether your school will be
  implementing the program
• If so, establish date and time so that you may
  communicate the information to your staff during
  the training

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Preparing for Your Staff Meeting/Parent Night

• Preview the Training Trusted Adults DVD
• Make sure the DVD is in working order
• Think about your own reactions to this video
• Consult the discussion guide, plan your talkback
• Personalize the discussion to your audience
• Review definitions (risk factors, etc.)
• Be prepared to communicate these terms to your
  staff
• Understand myths/facts about depression and
  suicide
• Refer to examples in your Implementation Guide

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Staff Meeting Step by Step

• Distribute disclosure guidelines for staff.
• Review your districts crisis response protocol.
• Review how staff should proceed if approached by
  a student for help.
• Show the Training Trusted Adults DVD.
• Facilitate a follow-up conversation using the
  discussion guide (including definitions,
  myths/facts).
• Allow extra time for q a with your staff.

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Parent/Community Night Step by Step

• Review your districts crisis response protocol.
• Show the Training Trusted Adults DVD.
• Facilitate a follow-up conversation using the
  discussion guide (including definitions,
  myths/facts).
• Review school policy for following up with
  at-risk students, including how and when
  parents/guardians will be contacted if their
  child needs further help.
• Encourage parents to talk to their children about
  depression, suicide, and mental health!
• Provide parents/guardians with school and
  community-based mental health resources in your
  area.

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Gatekeeper Training is a Crucial Part of Program
Design
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For more information contact

• Screening for Mental Health
• Meghan Diamon, LCSW
• mdiamon_at_mentalhealthscreening.org
• 781-591-5230
• Or visit
• www.MentalHealthScreening.org

Screening for Mental Health, Inc. One Washington
Street, Suite 304 Wellesley Hills, MA 02481 P
781.239.0071 F 781.431.7447 www.MentalHealthS
creening.org
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References

• American Psychiatric Association. (2000).
  Diagnostic and statistical manual of mental
  disorders (4th ed., text rev.). Washington, DC.
• Aseltine, R., et al. (2007). Evaluating the SOS
  suicide prevention program A replication and
  extension. BMC Public Health 7(161).
• Aseltine Jr., R.H. DeMartino, R. (2004). An
  Outcome Evaluation of the SOS Suicide Prevention
  Program. American Journal of Public Health, 94
  (03), 446-451.
• Centers for Disease Control and Prevention,
  National Center for Injury Prevention and
  Control. Web-based Injury Statistics Query and
  Reporting System (WISQARS) online. (2005)
  cited 2011 Feb.16.  Available from URL
  www.cdc.gov/ncipc/wisqars

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References

• Gould, M., et al. (2003). Youth suicide risk and
  preventive interventions A review of the past 10
  years. Journal of the American Academy of Child
  and Adolescent Psychiatry, 42 (4), 386-405. 
• Gould, et al. (2007). Evaluating Iatrogenic Risk
  of Youth Suicide Screening Programs. American
  Medical   Association, 293(13), 1635-1643.
• Kataoka, S. Zhang, L. Wells, K. (2002). Unmet
  need for mental health care among U.S. children
  Variation by ethnicity and insurance status.
  American Journal of Psychiatry, 159 (9), pp.
  1548-1555.
• National Alliance of Mental Illness (NAMI).
  (2003). Depression in Children and Adolescents.
  Retrieved on June 16, 2009 from
  http//www.nami.org/Template.cfm?SectionBy_Illnes
  stemplate/ContentManagement/ContentDisplay.
  cfmContentID17623

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References

• Schilling, E. A., Aseltine, R. H., Glanovsky, J.
  K., James, A., Jacobs, D. (2009). Adolescent
  alcohol use, suicidal ideation, and suicide
  attempts. Journal of Adolescent Health,
  44,335-341.
• Substance Abuse and Mental Health Services
  Administration. (2012). Results from the 2010
  National Survey on Drug Use and Health Mental
  Health Findings, NSDUH Series H-42, HHS
  Publication No. (SMA) 11-4667. Rockville, MD
  Substance Abuse and Mental Health Services
  Administration.
• UCLA Center for Mental Health in Schools. School
  community partnerships a guide. Retrieved from
  http//smhp.psych.ucla.edu/pdfdocs/guides/schoolco
  mm.pdf
• World Health Organization. (2006). WMO Statement
  on Adolescent Suicide. http//www.wma.net/en/30pub
  lications/10policies/a9/index.html.pdf?print-media
  -typefooter-rightpage/toPage