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 childÃs 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 ³ a more than 87% decrease in the suicide rate in three years ³ 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 studentsà 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 ‘tabooà 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 childÃs 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 DistrictÃs 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 ³ either directly to you in conversation or indirectly (e.g., through someone else or through an art or writing assignment) ³ 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 ³ 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 teamÃs 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 studentsà 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 ³ 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 ³ 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.
Read Education Week’s special two-part series on teen suicide
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