|
Saving
Kids from Suicide:
Contributing to Students’ Mental Health and
Resiliency
Some speculation
exists about the effectiveness of school suicide prevention. Assessing
the effectiveness of prevention programs can sometimes be difficult
to do. The statistics, however, indicate that youth suicide continues
to be a significant public health issue. According to the U.S. Surgeon
General’s Call to Action (1999), the rate of suicide during the
last ten years doubled for children between the ages of ten (10)
and fourteen (14), making it the fourth (4th) leading cause of death
for that age group; and suicide is the third (3rd) leading cause
of death for young people between the ages of 14 and 24. The challenges
faced by educators working to fulfill the promise of an education
for every child are considerable enough. Nevertheless, schools can
and do make important contributions to youth suicide prevention.
Angela Oddone,MSW, NEAHIN’s Mental Wellness Programs Coordinator,
offers these insights from research and experts working on suicide
prevention in schools.
What
do we know about the risk of suicide among school-age youth?
Research indicates
that girls are more likely than boys to experience having suicidal
thoughts, create a suicide plan, and attempt suicide. Boys, however,
more often successfully complete suicide than do girls. For grades
9-12, based on a representative sample of 16,000 students:
- 20.5% had
seriously thought about attempting suicide
- 15.7% had
made a specific plan to commit suicide
- 7.7% had
made one or more actual suicide attempts
- 2.6% had
made a suicide attempt resulting in injury or poisoning that required
medical attention during the last year.
This data, taken
from the US Centers for Disease Control (CDC)’s 1997 Youth
Risk Behavior Surveillance System (YRBSS), is based on students’
self report. As such, it does not predict directly how significant
the risk is for suicide among school-age youth. It does, however,
provide important insight.
Perspectives
on what causes suicide to happen:
There is some
disagreement among experts about how to classify the causes of suicide.
Psychologist and professor of psychiatry at Johns Hopkins University
School of Medicine Kay Jamison, PhD, in her book, Night Falls Fast:
Understanding Suicide, looks at suicide from a medical perspective.
This perspective views mental illness, including depression, as
the root cause and suicide as the result of mental illness that,
in some cases, may have been undetected or untreated. The good news
that comes with this perspective is that, particularly given the
significant expansion of medication options and the effectiveness
of medication when combined with talk therapy, treatment can be
and often is effective.
Other experts
are reluctant to label suicide victims or people who are at-risk,
particularly adolescents, as having a mental illness. Instead, they
utilize an environmental perspective that focuses on a particular
event or serious of events in a child’s life that preceded the suicide.
That lesbian, gay and bisexual youth are at higher risk for suicide
attempts than other teens is one illustration of the environmental
stress perspective.
Jon Sandoval,
PhD, co-author of Youth Suicide (1991) and professor at the University
of California-Davis’ Division of Education takes a middle ground
that incorporates contributions from both the medical and environmental
perspectives. Dr. Sandoval explains that teens are faced with developmental
issues and characteristics that are, in fact, normal for adolescence.
These issues and characteristics can sometimes render a “lack of
social capital” for at-risk youth who are faced with life experiences
for which they lack adequate support, problem-solving or coping
skills. Building on “social capital” can, therefore, be an effective
contribution to suicide prevention for adolescents. Impulsivity,
which is a characteristic of adolescence, needs to be taken into
consideration when doing suicide prevention work with this age group
because of the influence it has to close the window of opportunity
for rescue of a child in trouble.
What are
features to look for in a suicide prevention program?
The recently
released US
Surgeon General’s Report on Mental Health includes a report
on the remarkable success that the US Air Force has had with suicide
prevention. The Air Force suicide prevention initiative uses a system-wide,
community approach. In 1995, prior to implementation, the Air Force’s
suicide rate was almost 16 per 100,000. Three (3) years after implementation,
the rate decreased to below two (2) per 100,000.
The Air Force
initiative has involved education on suicide risk awareness, reducing
barriers to mental health services, and efforts to reduce the stigma
that is often associated with mental health problems. The strategy
for this initiative involves four key points in the system: 1) buddies,
2) supervisors, 3) “community gatekeepers” (e.g., chaplains or mental
health providers), and 4) health care professionals. Level one,
emphasizing peer connection and support, is called “buddy care.”
An official with the Air Force Surgeon General (1997) explains,
“We tell everybody, these are the warning signs to look for in your
buddies and this is what you do if somebody is showing these signs:
Notify someone in Level Two.” Each subsequent level supports and
responds to the level preceding it. The Air Force’s remarkable success
– a more than 87% decrease in the suicide rate in three years –
indicates that a system-wide, community-based approach to suicide
prevention holds significant promise.
For many reasons,
suicide prevention can be a somewhat controversial topic. Sometimes,
it is difficult to assess the effectiveness of prevention programs.
Some research suggests that general education programs that teach
the facts, warning signs and risk factors associated with suicide
have succeeded in imparting knowledge but may have had little impact
on changing students’ attitudes about suicide and the importance
of seeking help.
According to
CDC (1992), “Persons considering school-based general suicide education
as a prevention strategy should also recognize that not all curricula
are necessarily well-conceived.” CDC says that, when making decisions
about a suicide prevention curriculum, it is important to make sure
that the curriculum selected does not sensationalize suicide. It
should also be careful to not ‘normalize’ suicide in such a way
that could render a negative impact by “lessening whatever protective
effects may derive from the social ‘taboo’ associated with suicide.”
Jon Sandoval
offers some insights on what makes for a responsible suicide prevention
curriculum, stating, “It is important to not romanticize suicide.
Make sure that suicide is not discussed as potentially being an
attractive way to make a point to others. Make clear, particularly
with adolescents, that any fantasies they might have about somehow
being able to witness the effect of suicide on others are unrealistic.”
Current research indicates that broad-based primary prevention that
focuses on overall health enhancement may be more helpful than programs
that narrowly focus only suicide. The National Institute of Mental
Health agrees with the broader approach, stating that suicide prevention
within a broader mental health focus that includes addressing the
enhancement of coping skills and dealing with risk factor issues,
such as substance abuse, are more likely to be successful than those
that address suicide alone.
Why should
schools get involved?
A child’s problems,
particularly difficulties with academic achievement, are often more
evident at school than they are at home. A correlational link between
suicide and school performance has actually been measured in research.
According to a 1988 study, seventy six percent (76%) of 229 youth
who committed suicide experienced a significant decline in academic
performance in the year prior to their deaths.
Consultation
with school personnel and school visits offer a mental health professional
useful insights as to how a child client is relating to peers. Child
mental health professionals do classroom visits and teacher consultations
not only to learn about a child’s academic performance but also
to see first-hand and tap into teachers’ expertise and observations
about a child’s social skills and competence. Does the child have
friends at school? Does the child make friends easily? How does
the child handle conflict with peers? It is not unusual for one
of the most useful information sources for a child’s therapist to
be the child’s teacher.
What do teachers
and other school personnel need to know?
Teachers and
other school personnel need to know that when suicide is a concern…
…You are
not held to confidentiality.
Acting to prevent a potential suicide always overrides the need
to honor confidentiality between yourself and a student. Says Rosemary
Rubin, M.S., school counselor/consultant at the Los Angeles Unified
School District’s Suicide Prevention Unit, “Teachers need to know
that there is no confidentiality when a child is talking about suicide.”
…Act immediately.
If a child discloses – either directly to you in
conversation or indirectly (e.g., through someone else or through
an art or writing assignment) – that he or she has had thoughts
about suicide, it is essential that you take action immediately.
If, for example, disclosure occurs during an early morning class
period, report it then, not several hours later after school has
ended for the day.
…Take any
indication of suicide risk seriously.
Youth who are at risk of suicide will sometimes make
statements such as, “I want to die.” Often, however, statements
will not be so clear – e.g., “The world would be better off without
me,” or “I want to go far, far away.” Statements such as these are
not clear threats; however, they still may create concern. No one
can know for sure. Ms. Rubin encourages school personnel to treat
all statements or indications seriously. It is important to not
minimize. Even if you have some doubt about what you have seen or
heard or about what has been reported to you, it is still essential
that you take action to respond.
What should
you do to take action?
If your school
has a crisis team, utilize the team’s resources. If at all possible,
do not take on this issue alone. A potential suicide is not something
you should try to respond to or handle solo. Contact and work with
the school counselor, psychologist, social worker or school administrator.
When a student
has been assessed to be a suicide risk, school personnel should
immediately contact the students’ parents or legal guardian. Schools
need to have established crisis plans that can guide school personnel
on what steps they need to take, including assigning specific roles
and outlining concrete procedures. Making sure that you are familiar
with what the roles and procedures are for your school can be reassuring
and can make responding to a child’s disclosure or to observation
of warning signs an easier thing to do.
It is difficult
to tell a parent that his or her child has expressed suicidal feelings.
Parents often engage in denial or self-blame when they learn that
their child is considering ending his or her life. Ms. Rubin explains
that, when she talks with parents, she sometimes uses the analogy,
“If your child has a broken arm, you take him or her to the doctor.
This is just another part of your child that is in pain,” to help
parents hear what she has to say and to encourage them to take action
to get help for their child.
School personnel
can also help to connect a student at risk of suicide with mental
health resources. At Los Angeles Unified School District’s Suicide
Prevention Unit, a list of community mental health agencies is updated
each year to facilitate referrals for students needing professional
help.
In concert with
research-based recommendations calling for a broad-based approach
– an approach that broadly covers mental health by including skill-building,
resiliency enhancement, and prevention and intervention on identified
risk factors (e.g., substance abuse) rather than one that focuses
only on suicide – schools can utilize system-wide, community-based
prevention strategies, such as what the US Air Force initiative
has done. Transition support programs, for example, for students
entering middle or high school or for students who are new to a
school as a result of a geographical move, can foster positive peer
relationships and enhance students’ connections to school.
A conspiracy
of silence often surrounds suicide. Yet, suicide is a significant
and serious public health issue. Although suicide prevention may
be controversial, school personnel can play an important role in
prevention by not participating in a conspiracy of silence. The
more we know, the better prepared we can be to help students who
may be at risk.
Warning Signs in Youth
Back to NEA HIN Mental Wellness
|
