Critical Event Support with County of San Diego

Guidelines for Student or Staff Sudden Death (Part 3)

General Prevention Strategies

Ninety-five percent of youth suicides can be prevented. Only five percent of the adolescents who attempt suicide display psychotic symptoms such as disorientation, hallucinations, or thought disturbances and are intent upon self-destruction. Further, poor school adjustment—including poor grades, truancy, and discipline problems at home or school—may contribute to a student's level of risk. The school may want to consider implementing preventive measures with school personnel, students, and parents as suggested below.

School Personnel

School staff often feel anxious when confronted with a teenager who says he or she is suicidal. That anxiety often is the result of inadequate training in dealing with self-destructive behavior. For a school to have an effective intervention program, however, staff members must become involved with troubled youth.

Certainly suicidal young people should be referred for professional help, but equally important is the support they receive in relationships with other caring people, be they teachers, parents, or friends. Early intervention by any caring person can be a lifeline to be grasped while other steps are taken. Training school staff to recognize potentially self-destructive students carries little risk and could save lives.

Training and utilization of school personnel should include the following:

1. Arrange in-service training on stress in children and adolescents and methods for reducing stress in a school environment.
2. Provide in-service training on recognizing the signs of substance abuse, sexual abuse, physical abuse, depression, and other handicapping disorders that could make a student suicidal. Early identification should be emphasized. Referrals can be made to the crisis team with follow-up memoranda of all referrals. Educators must become better observers of students' behaviors, more supportive, and less prone to labeling of deviant behavior when it occurs in their classrooms.
3. Delegate the leadership for implementing a youth suicide prevention program to a crisis intervention team selected from willing and qualified faculty. The team may consist of administrators, guidance counselors, school psychologists, nurses, social workers, or qualified teachers. A supportive staff member such as a secretary may also be very effective on a crisis team.
   • Select one member from the team (preferably by the team) to be the team's formal leader.
   • Educate the team members about crisis intervention techniques, including the philosophy that crisis intervention is not psychotherapy, but is an easy way to restore students to their former emotional and behavioral states.
   • Emphasize the importance of follow-up of referrals. A large number of students who may be at risk never receive help, although help is desperately needed and often desired. Schools should adopt policies concerning students who refuse help or are unable to receive needed help because of finances or lack of parents' cooperation.
4. Develop written policies and procedures for dealing with suicidal or depressed youths. Written policies or procedures on how to intervene with youths suspected of abusing drugs are imperative. A policy can include the following:
   • When and how to refer to the crisis team
   • When and how to inform parents
   • When and how to inform administrators
   • When and how to counsel the youth
   • How to obtain an assessment of the potential and capability of causing death (lethality)
   • When and how to refer the youth to a mental health center

Students

Perhaps the most controversial part of a school-based suicide prevention program is teaching prevention to students. Yet students may be the first to recognize that a friend or acquaintance may be suicidal. Many times a potentially suicidal student will state his or her intentions to friends. If students know the warning signs of self-destruction and know where to refer a friend, they can be a great resource in the suicide prevention effort. Other steps the school may want to consider are as follows:

1. Develop a health curriculum for every student with the following suggested topics:
   • Positive self-esteem with an "I'm okay, you're okay" focus
   • Effective interpersonal skills with peers and adults including beginning, maintaining, and terminating relationships (Learning social skills for dating and school activities can be beneficial.)
   • A positive attitude toward loss, failure, and grief (Learning how to fail is as important as learning how to succeed.)
   • Life skills, including decision making, values clarification, and problem solving
   • Stress management skills
   • Substance abuse information and the effects of drugs on the body
   • Depending on the community and school governing board stance, a component related to sexual topics and/or other health topics such as AIDS
2. Develop a peer support program (sometimes called peer counseling) with components such as the following:
   • Youth-staffed hotline
   • Problem-solving with a peer (Note: The National Youth Suicide conference emphasized avoiding the phrase peer counseling, as it can be misleading to students. It is recommended that peer counseling be called peer support, and the focus be on support.)
   • Self-help groups for maltreated teenagers and for other students who would benefit from a group experience, such as those whose parents are divorcing or those who have suffered the death of a parent
3. Develop a pamphlet for youth on guidelines for recognizing maltreatment and ways to help maltreated peers.
4. Prepare school newspaper articles.
5. Present school plays or show films on the problem of youth suicide, and follow up with resources for help.

Parents

Parents are often aware that their children, or their children's friends, are experiencing difficulties, but are hesitant to label such difficulties as serious or to consider these children at risk for suicidal behavior. Schools can assist parents to become better observers and to identify times to seek help for their children by holding workshops to educate parents about indicators of substance abuse, depression, and suicide. Workshops can focus on ways to prevent youth suicide and describe the relationships among substance abuse, depression, and suicide. Parents should be educated on how to have more effective communication with their children. Many parents, devastated by the suicide of a son or daughter, recall certain behaviors that may have indicated a potential for the suicide. Others feel that there were no warning signs. No parent can fully know what to expect, but there are things a parent can know and do that might prove helpful in saving a child.

Parents of young people should observe these guidelines:

• Be aware that extreme behavior patterns are not necessarily normal or characteristic of all adolescents. Such behavior may be a sign that a child is disturbed.
• Don't assume that bouts of depression by a child are just a stage that will pass with time. For teens who have limited coping skills, mild depression can turn to deeper depression accompanied by thoughts of suicide or other forms of self-destructive behavior.
• Be aware of a son's or daughter's involvement with school, peers, and community.
• Be empathetic when problems such as a failed romance occur. For some adolescents, such perceived failures can create an emotional crisis.
• Recognize that major changes in the family structure can be very difficult for an adolescent. Such trying situations may include separation and divorce, living in a step-family, or a change in residence or school.
• When major changes in a child's personality are observed, seek an opinion from a qualified mental health professional.
• Work with school teachers and counselors when there is a problem.

Conclusion

Having an effective suicide-prevention program in a school depends on the participation of students and parents in all aspects of the program. Excellent parental and student resources can be found in every school.

Involving parents and students in the development and implementation of a prevention program and delegating the responsibility for implementing the program to a trained crisis team is a good first step toward preventing youth suicide.

The next step is to enlist community support. Identify community support services for youths. If there are none, start some. Schools also must maintain a collaborative relationship with community agencies involved in suicide prevention, education, and intervention. Outside agencies can serve as consultants, referral sources, and trainers of staff and students. By maintaining a collaborative relationship, follow-up of referrals can be better realized, particularly if there is a mental health liaison person at each school who can serve as the leader of a crisis team.

Many physicians and counselors in private practice may be willing to help with the problem of youth suicide and should be invited to do so. A list of community resources dealing with the problems of adolescence should be developed and distributed to all youths and their families.

Although not all suicidal students will become the responsibility of the special education program, special education personnel and services are important to the effectiveness of a school suicide prevention program. For exceptional students, an appropriate special education program may be an important contribution to suicide prevention.