Transcript suicide attempts - STAR

Paula S. McCommons, Ed.D
1
Let us not look backward in
anger or forward in fear but
around us in awareness.
James Thurber
2
Today’s Goals
 Review factors that impact
prevention and intervention efforts
 Identify what we know about how
youth suicide happens – risk factors
and warning signs
 Explore our role in prevention and
intervention of youth at risk
 Describe resources and self-care
strategies for youth , families and
caregivers/ourselves
2003
3
You are the “human tool.”
Looking in a mirror… are you looking back
at a caring adult in a child’s life?
One of the wonderful things we now
see in adulthood is that these children
really remember one or two teachers who
made the difference.
They mourn some of those teachers
more than they do their own family
members because what went out of their
lives was a person who looked beyond
outward experience, their behavior and
often unkempt appearance, and saw the
promise.
(Werner , 1992)
5
Being kind. Offering choice.
Modeling Self-care.
Refer to NAMI handout on
Mental Health Facts
7
Please take a moment to complete
the “Suicide Awareness Quiz”
8
Mental Health Awareness and
Treatment
 1/5 youth meet the criteria for a mental
health dx. and yet only 1/5 ever get the help
they need
 Mental health issues tend to run in families
 Diagnosis (dx) are often co-occurring,
meaning you will have more than one
diagnosis at a time
 Self-medicating often becomes another dx.
9
Challenges of Diagnosing & Treating
Mental Illness Among Youth:
 Behavior is complex – not like an x-ray of a
broken bone
 Health parity does not always play out – many
blocks to appropriate treatment
 Caregivers may also be in need of treatment
and/or support
 Stigma https://www.youtube.com/watch?v=5P5E_QHA
8BA&feature=youtu.be
10
Other Factors Impacting Prevention and
Intervention Efforts
 Mental Health Awareness and Treatment
 “Normal” Development
 Brain Development
 Sleep Hygiene
 Previous Loss and Trauma
 Visual Exposure and Uncensored
Technology – Information Overload
 Family Strains and Discord
11
“Normal” teen and young adult
development may lead to …
 Non-compliance with treatment
 Self-medication
 Teens confiding in peers rather than
adults
 Vulnerability to peer influences and
behaviors
12
How many of you would pick your
teen years as the “best years of your
life”?
Causes of Mental Illness (MI): A
Combination of Factors
 Heredity (genetics) – a predisposition but not a
guarantee
 Biology – Chemical imbalances among
neurotransmitters may cause brain
communication errors/difficulties .Brain Injury or
defects may alter functioning and mood.
 Psychological Trauma – i.e abuse, neglect, loss
 Environmental Stressors –i.e. witnessing
violence, may trigger a mi in those who are already
vulnerable to a mi
14
Diagnosis of Mental Illness Among
Youth:
 Rule out physical causes – meet with
pediatrician
 Evaluation – gather “data” from youth,
parent, teacher and other caregivers
 Behavioral Health Specialists – psychiatrist,
psychologist, clinical social worker, and
licensed counselor
15
Treatment of Mental Illness Among
Youth:
 Medication – especially given the
connection with bio-chemical imbalances in
the brain
 Psychotherapy -CBT (cognitive behavioral
therapy), group and family are common
 A combination of meds and therapy
 Creative therapies - i.e. art, equestrian and
play
16
Prognosis of Youth with Mental Health
Disorder:
 With appropriate treatment youth may
experience recovery from or at least a
successful management of their symptoms.
If untreated youth may become adults at
greater risk for substance abuse, and selfinjury, including suicide.
17
www.jedfoundation.org/CampusMHAP_Web_final.pd
f
18
Informed Trauma Care: Creating a
Community Meeting
 Not therapy
 Instill sense of community – “We”
 Increase self-awareness & help seeking
 Re-enforce safety
 Offer hope
19
A “Grounding Conversation/Meeting: All
members answer 4 ?’s”:
 My name is __________________.
 I am feeling ____________________.
 My goal for today is _______________.
 I know I can get _________________to help
me with my goal.
Remember replace “What is wrong with
you? with “What has happened to you?”
20
http://www.sprc.org/sites/sprc.org/files/library/RiskPr
otectiveFactorsPrimer.pdf
21
2013 National Youth Behavior Survey
Results: In the past 12 months…
 Nearly 30% of students reported feeling so sad or
hopeless almost every day for 2 weeks or more that
they stopped some usual activities * this was not a
significant increase from 2011
 17% seriously considered suicide (more females
(22%) than males (11%
 13% made a plan
 8% attempted at least 1 x (10% female & 5% male)
 Nearly 3% of attempts required medical treatment
 http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf
22
2013 College and University Student
Health Survey and Research
 More than half of college student reported feeling so
overwhelmed, anxious or depressed that it impacted
their daily functioning
 Majority of suicides did not occur on campus and often
involved older/graduate aged students
 Overwhelming majority of students who died by
suicide were not involved with the college campus
counseling services
 http://www.acha-ncha.org/docs/ACHA-NCHAII_ReferenceGroup_ExecutiveSummary_Spring2013.pd
f
23
http://www.halfofus.com/video/emotional-health-101/
24
The connection between depression and
suicide. Refer to NIMH handout on teens
and depression.
25
Risk Factors for Youth Suicide
 Depression or bipolar
disorders
 Self-harm behavior
 Behavior problems
 Hopelessness
 Involvement with bullying
 Drug or alcohol abuse
as target and/or aggressor
 Current or past abuse
 Availability of firearms
 High suicidal intent
 Previous attempt
 Co-existing condition
 Suicidal behaviors
 Legal or disciplinary crisis
 Lack of treatment
 Family history of suicidal
behavior
 Unsupported GLBTQ youth
 Insomnia
26
Suicidality and Depression
 Depression is the strongest and most common
correlate with suicidal ideation and behavior
 60% of suicide victims had a mood disorder and up
to 80% of suicide attempters do
 Depression in combination with other comorbidities
(anger/impulsivity, anxiety or distress) greatly
increase risk for suicide attempt
 Depression is a treatable illness
 Educate teen and family on the illness and be
realistic about the often lengthy road to recovery
 Offer HOPE and remind all of innate resiliency that
can be strengthened
27
Statistics and Research
 8.3 % of adolescents; 2.5 % of children
 Depression occurring earlier than in previous
decades
 Early onset depression often persists, recurs and
may predict more severe illness in adulthood
 Associated with an increased risk for suicidal
behaviors
28
Myths About Depression
 It will go away on its own
 Everyone feels this way
 Having depression or seeking help is a sign of weakness
 If a depression is mild, you don’t have to worry about
suicide
 People or events “cause” depression
 Children don’t get depressed
 Moodiness in adolescents is normal
29
Symptoms of Depression
 Depressed mood/Irritability
 Loss of interest/pleasure
(anhedonia)
 Changes in sleeping patterns
 Changes in eating
patterns/weight
 Increased agitation or a slowing
down of thought, speech or
movement
 Low self-esteem
 Excessive guilt
 Difficulty
concentrating/making
decisions
 Social isolation
 Increased aches and pains
with no physical cause
 Persistent thoughts of
death/suicide
 Fatigue/loss of energy
30
Types of Depression
 Major Depression
 Bipolar Disorders (I and II)
 Dysthymic Disorder
 Seasonal Affective Disorder
 Depression, Not Otherwise Specified
31
Other Factors for College Students:
 The following factors may exacerbate mental
health conditions such as depression and anxiety:
 Major life transitions – i.e., leaving home, family
and peer supports
 Pressures to succeed
 Uncertainties about the future job market
 Increased financial burdens, especially for
graduate students
 Increased drug and alcohol use
 Insomnia - “all nighters”
32
Causes of Depression
 Genetic/Familial Factors
 Research shows that
depression tends to run in
families.
 Parents are not to “blame” if
their teen becomes
depressed
 Biochemical Factors
 Research supports that some
depressions are caused by a
chemical imbalance in the
brain.
 This is why medications may
help
33
Causes of Depression
 Cognitive and Social
Skills
 A tendency toward
negative thinking and/or
problems interacting
with others are often
factors in teen
depression.
 This is where
psychotherapy can help
 Environmental Factors
 Loss, stress, life events,
and chronic illness can
“trigger” depression
34
Types Of Treatment
 Psychotherapy: Individual,
Group, Family, Maintenance
Plan
 Coping skills
 Emotion regulation skills
 Communication skills
 Social skills
 Medication Treatment
 Non-addictive
 Potential side effects
 Combination psychotherapy and
medication treatment often
works best
Risk Factors for Adolescent Suicide
 Depression or bipolar
disorders
 Self-harm behavior
 Behavior problems
 Hopelessness
 Involvement with bullying
 Drug or alcohol abuse
as target and/or aggressor
 Current or past abuse
 Availability of firearms
 High suicidal intent
 Previous attempt
 Co-existing condition
 Suicidal behaviors
 Legal or disciplinary crisis
 Lack of treatment
 Family history of suicidal
behavior
 Unsupported GLBTQ youth
 Insomnia
36
Suicide Continuum
Passive
death wish
Suicidal ideation Suicidal ideation
no method
with plan
Suicide
Attempt
Completed
Suicide
Suicidal Ideation
Non-suicidal self-injury
37
Brent et al., 1988
Precipitating Events to Suicidal
Behavior:
 Perceived overwhelming distress following an “critical”
event:
 Break up
 Impending legal and/or disciplinary action
 Academic decline
 Being “outted”
NOTE:
The event does NOT cause the individual to become
suicidal. Suicide is the result of a complex set of
factors.
38
Sleep and Self-Injurious Behavior:
NSSI and Suicidal
 Insomnia was strongest depressive symptom in the
week prior to suicide (Goldstein et al., 2008)
 Insomnia also associated with increased risk of selfharm and suicidal ideation even when controlled for
depression (Wong et al., 2011, 2012)
 Treatment for depression does NOT necessarily
improve sleep and some medication can make it
worse
 Again, we need to educate teen and family and be
realistic about progress and emphasize sleep hygiene
39
40
https://www.
youtube.co
m/watch?v=
3BByqa7bht
o
41
A pneumonic device to assess
suicidal acute risk.
42
The prediction of future suicidal behavior is
NOT measurable; however research does
identify risk factors and “favorable”
conditions for a completed suicide.
43
Protective Factors Identified for Reducing
Suicidal Behavior: None Identified for NSSI
 Family and school connectedness (Kaminski et al.,
J Youth Adol, 2010)
 Reduced access to firearms (Grossman et al.,
JAMA, 2005)
 Safe schools (Eisenberg et al., J Ped, 2007)
 Self-esteem (Sharaf et al., JCAPN, 2009)
 Academic achievement (Borowsky et al.,
Pediatrics, 2001)
(Refer to Youth Suicidal Behavior Fact Sheet, National
Center for the Prevention of Youth Suicide)
44
More Protective Factors…
 Family meal times
 Regular exercise and sleep
 Parent supervision
 Support and treatment for parent
stress/illness
 Address school issues such as bullying,
attendance and missing school work
45
Reflection: Ask yourself these questions. . .
 Could one prevention approach meet the needs of
these young people?
 Why do we need to ask prevention program
developers, “What is your model for how suicide
occurs?”
 What are the prevention approaches that address
the risk factors and precipitating events identified
in the literature?
 Given your experience and role (s), what would you
suggest?
2003
46
Some illustrations and scenarios
A teenager has experienced repeated episodes of
depression and feels hopeless, despite some
sessions with a school counselor. Her parents
have refused to let her see a psychiatrist. When
her parents leave for a weekend of partying with
their friends at a football game, she concludes
that she would be better off dead and overdoses.
2003
47
A scenario
 A graduating senior returns from Spring
break only to receive news that her fifty-two
year old father has died by suicide . He had
suffered a heart attack when she was in high
school but seemed to recover. After twenty
plus years of service her Dad had recently
been laid off. He had also served in the Gulf
War.
48
Another scenario
On the way to school Friday morning the bus
driver hears Taylor tell Olivia , her best friend,
the following, “My Mommy and Daddy are
getting a divorce and my Daddy wont live with
us anymore. I don’t want to live without my
Daddy. My Mommy is going to visit my
grandma this week-end and I am going to take
her pills from the medicine cabinet.” After the
students unload the bus driver tells you what
he heard.
49
Another illustration
A gifted teenager has experienced severe anxiety
for several years. Treatment has helped, but he
continues to be self-critical and overly
concerned about his performance and others’
approval of him. When he is caught parking his
car on school campus without a student permit,
he faces a one-day suspension. Panicked about
his parents’ reaction, he drives the car to a bridge
and jumps.
2003
50
And another
Diagnosed at age 8 with Conduct Disorder and
ADHD, this 14 year-old struggles academically.
He compensates for his poor academic status by
being the class clown and taking risks to gain the
attention of his friends. One night at a friend’s
house, he drinks with the other kids and then
plays a fatal game of Russian Roulette.
2003
51
One more
A young woman experiences a romantic
break-up and becomes depressed. She
encounters her former boyfriend on the
street with a new partner. She returns to
her college dorm and hangs herself.
2003
52
Reflection: Ask yourself these questions. . .
 Could one prevention approach meet the needs of
these young people?
 Why do we need to ask prevention program
developers, “What is your model for how suicide
occurs?”
 What are the prevention approaches that address
the risk factors and precipitating events identified
in the literature?
 Given your experience and role (s), what would you
suggest?
2003
53
Suicide Prevention in the USA :
A Brief Recent History
 1999 Surgeon General declares suicide a public health
threat
 Each state charged with formulating a comprehensive
across the life span plan
 2011 National Prevention Strategy outlined nation’s
plan for promoting health & wellness
 2012 National Action Strategy for Suicide Prevention
released four strategic directions – joint efforts of
Surgeon General & National Action Alliance for
Suicide Prevention
Four Strategic Directions
1. Create supportive environments
2. Enhance clinical and community preventative
services
3. Promote availability of treatment and
supportive services in a timely manner
4. Improve suicide prevention surveillance
collection, research and evaluation
http://www.surgeongeneral.gov/library/reports/nati
onal-strategy-suicide-prevention/full-report.pdf
National and Legislative Updates cont.
 2014 Action Alliance released Effective Suicide
Messaging Guidelines covering the:
 Strategy – Who is the audience? What is the
intended outcome? How will it be
measured?
 Safety – Does content and delivery follow
best practice guidelines –
www.sprc.safeemessaging
 Positive Narrative – Are hope, recovery and
resources/support emphasized?
56
57
Refer to handouts for examples and
recommendations
58
2013-14 Student PSA Winners
 Posters, 30 and 60 second audio and video PSA
 Needed faculty sponsor and follow media guidelines on
reporting on suicide
 http://www.nimh.nih.gov/health/topics/suicideprevention/recommendations-for-reporting-onsuicide.shtml
 Review winners at: www.payspi.org

http://Aevidum Club founded at Calico High School
 If depression were as easy to spot in the hallway as a
banana… www.aevidum.com
National and PA Legislative Updates cont.
 Act 71 passed in June 2014 to go into effect 2015-16
school year. PA becomes one of only twenty states
requiring some type of staff education on suicide
prevention. Schools…
 Must have a comprehensive suicide policy
 Must, in conjunction with the Dept. of Ed., offer 4
hrs. of suicide prevention training every 5 yrs.
 May incorporate an age appropriate suicide
awareness and prevention curriculum
 PA Youth Suicide Prevention Initiative to provide
no cost resources for schools – www.payspi.org
60
More Good News…
 In 2015 PA received 5 yr SAMHSA grant to
focus on suicide prevention in schools and
higher education.
 We now have an interactive state calendar
for suicide prevention activities at a county,
regional and state level
 Visit – www.payspi.org
61
PA Higher Education Suicide Prevention Coalition
• Collaborative formed to enable colleges, community colleges, and
universities across Pennsylvania to discuss efforts toward suicide
prevention on campuses
• Currently just over 50% of campuses are participating in the
coalition
• Participation includes monthly web-based video meetings, as well
as one face-to-face meeting each of the five years of the project.
• For more information or to participate contact
[email protected]
Download your free copy at :
http://store.samhsa.gov/shin/content/
/SMA12-4669/SMA12-4669.pdf
http://www.sprc.org/collegesanduniversities
64
Six Steps to Comprehensive Suicide
Prevention in Schools
Screening
Student
Education &
Advocacy
Identification
& Response
Parent
Education
Postvention
Staff
Education
SAMHSA,
2012
In Other Words, Schools Need...
 Policy and procedures to govern suicide prevention,






intervention and postvention efforts
Training of specialized staff to respond to identified
youth who may be at risk or in imminent danger
“Gatekeeper training” of school personnel regarding
identification , referral and resources for at-risk youth
Parent education on referral resources and prevention
strategies including enhancing protective factors
Student education around peer referral
Screening for behavioral health issues
Postvention procedures to address a death by suicide
66
Six Steps to Comprehensive Suicide
Prevention in Schools (SAMHSA)
1. Protocols for helping students at risk of
suicide, including:
»»A protocol for helping students who may be
at risk of suicide
»»A protocol for responding to students who
attempt suicide at school
»»Agreements with community providers to
provide behavioral health services to students
Working with Students At-Risk for
Suicide
 Immediate evaluation – Every PA County must have a




emergency services system. Call 211
Parents are notified and asked to come and take the
child to evaluation
If student refuses, parent can do a 201
If parent and student refuses and child is in imminent
danger, conduct a 302
Work with solicitor for best practice on transporting
students to hospital or on a case by case basis
Six Steps to Comprehensive Suicide
Prevention in Schools
2.
Protocols for responding to suicide
death (Postvention), including:
»»Steps to take after the suicide of a
student or other member of the school
community
»»Staff responsible for taking these steps
»»Agreements with community partners
to help in the event of a suicide
Six Steps to Comprehensive Suicide
Prevention in Schools
3. Staff education and training, including:
»»Information about the importance of
suicide
prevention for all staff
»»Training, for all staff, on recognizing and
responding to students who may be at risk of
suicide.
»»Training, for appropriate staff, on assessing,
referring, and following up with students
identified as at risk of suicide.
QPR Gatekeeper Training for
Suicide Prevention
 Educational program designed to teach "gatekeepers"--
those who are strategically positioned to recognize and
refer someone at risk of suicide (e.g., parents, friends,
neighbors, teachers, coaches, caseworkers, police
officers)--the warning signs of a suicide crisis and how to
respond by following three steps:
http://www.qprinstitute.com/gatekeeperonline.html
 Question the individual's desire or intent regarding
suicide
 Persuade the person to seek and accept help
 Refer the person to appropriate resources
71
Six Steps to Comprehensive Suicide
Prevention in Schools
4. Parent education, including:
»» Information for parents about suicide and related behavioral
health issues
»» Strategies to engage parents in suicide prevention programs
5. Student education, including:
»»One or more programs to engage students in suicide
prevention
»»Integration of suicide prevention into other student healthy
behavioral health initiatives
http://www.paspi.org/PSA_Contest.php
Student Education & Prevention
Programs
 Suicide Prevention Resource Center -Best Practice Registry
http://www.sprc.org/bpr
 The purpose of the Best Practices Registry (BPR) is to
identify, review, and disseminate information about best
practices that address specific objectives of the National
Strategy for Suicide Prevention.
 The BPR is a collaborative project of the Suicide
Prevention Resource Center (SPRC) and the American
Foundation for Suicide Prevention (AFSP). It is funded by
the Substance Abuse and Mental Health Services
Administration (SAMHSA). Many of the best practice
resources listed have to be purchased.
NREPP:
prevention,
screening,
gatekeeper
education,
postvention
Who Should
Do Suicide
Prevention
Curricula with
Students?
Student
Education &
Advocacy
In Other Words, Comprehensive
Suicide Prevention Includes…
 Policy and procedures to govern suicide prevention,






intervention and postvention efforts
Training of specialized staff to respond to identified
youth who may be at risk or in imminent danger
“Gatekeeper training” of personnel regarding
identification , referral and resources for at-risk youth
Parent education on referral resources and prevention
strategies including enhancing protective factors
Youth education around peer referral
Screening for behavioral health issues
Postvention procedures to address a death by suicide
77
http://www.sprc.org/sites/sprc.org/files/library/colleg
e_sp_whitepaper.pdf
78
Suicide is the result of a complex set of
variables but prevention is possible
when some of these variables are
effectively addressed.
79
Please take a moment to complete
the “Suicide Awareness Quiz”
80
How does youth suicide happen?
 Researchers have pinpointed (1) a set of risk
factors that can lead to completed suicide.
 Researchers have also described (2)
precipitating events that contribute to
completed suicides.
 (3) Other researchers are investigating a
“suicide gene”.
2003
81
(1) Risk Factors for Completed
Suicide
 Mental illness such as
depression, bipolar
disorder, anxiety/mood
disorder, disruptive or
conduct disorder. These
often are associated with
hopelessness and
previous suicide
attempts.
2003
 Family history of suicidal
behavior and/or mental
illness/ Extreme family
discord
 Alcohol or other drug
abuse
82
(2) Precipitating Events for
Completed Suicide
 Exposure to another's suicide
 Legal or disciplinary crisis
 Availability of firearms
2003
83
(3) A Suicide Gene May Be Linked to Some
Suicides
 Bakish, et al.,( 2000) – investigating a genetic trait
or mutation
 Mann (2001, 2011) – suggests individuals may not
only “inherit the illnesses that trigger suicidal
feelings, but that they may also inherit a
predisposition to act on their feelings”; they may
inherit a “variant gene” that makes them more
prone to attempts
 Not to be confused with suicide genes used in
some cancer therapies
2003
84
Risk Factors: Mental Illness
 In over 80% of community and referred cases of
suicide attempts, there are associated mental
illnesses, most often depressive, anxiety,
conduct or substance abuse disorder disorders.
 Psychiatric diagnoses (most often mood
disorders, substance abuse disorder, conduct
disorder, bipolar disorder w/ mixed state), often
in combination, are present in about 90% of
teen deaths by suicide.
2003
85
Anxiety Disorders
 Co-existing with a mood disorder, these
conditions can interfere with a person’s
treatment and recovery.
 If not identified and targeted, these
disorders can increase the risk for suicidal
thoughts and/or behaviors in depressed
individuals.
2003
86
Depression in the Family
 Children of depressed
parents appear to be
at substantially
increased risk for
death by suicide.
(Brent, et al., 1994)
2003
87
Family Discord
 The most common precipitant for suicidal behavior
and suicide is parent-child discord.
 Discordant, hostile family interactions predisposed
[youth] to suicidal thoughts. (Kosky et al., 1986, p. 527)
 Suicide victims had less frequent and less satisfying
communications with their parents. (Gould et al.,
1996)
2003
88
Risk Factors: Drug and Alcohol
Abuse
 Children of substance-abusing
parents appear to be at substantially
increased risk for completed suicide.
 Alcohol acts as a disinhibitor to
suicidal behavior.
 A link seems to exist between alcohol
abuse and suicide by firearms.
Adolescents who are depressed and
use alcohol are more than 5x more
likely to use a firearm
2003
89
Risk Factors:
Exposure to the Suicidality of Others
 Exposure to a classmate’s suicide attempt may
prompt suicidal behavior in other students. Those
most vulnerable to “contagion” are more isolated,
were not close to the suicide victims, and have
other associated risk factors. Among close friends
and acquaintances of adolescent victims, exposure
does increase the incidence of depression, anxiety
and PTSD.
 Exposure to TV programs and news stories on
suicide may prompt suicidal behavior in
vulnerable adolescents.
2003
90
Risk Factors: Disciplinary Action
 A pending disciplinary crisis might
precipitate suicidal behavior.
 Discipline should occur as soon as
possible after misbehavior to decrease
the feelings of anticipatory anxiety.
 Involve parents and be sure and
emphasize the behavior does not define
who they are or will be. Offer a way out.
2003
91
Juvenile Suicide in Confinement: National
Survey (Hayes, 2009)
 23% of suicides involved youth who also engaged in
previous non suicidal self-injury
 Only 35% of suicide victims who completed during
time in a detention facility received a mental health
evaluation
 Less than half of all victims had never been assessed
by a mental health professional or had not been
assessed within 30 days of their death
 Less than 20% of those who completed were on suicide
precaution status at the time of their death; those who
were died within 15 minutes of their last observation
92
Precipitating Events to Suicidal
Behavior:
 Perceived overwhelming distress following an “critical”
event:
 Break up
 Impending legal and/or disciplinary action
 Academic decline or not attending school
 Being “outed”
NOTE: The event does NOT cause the individual to
become suicidal. Suicide is the result of a complex set
of factors. Many of these factors can be mitigated and
may save a life.
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http://www.afsp.org/preventing-suicide/oureducation-and-prevention-programs/programs-forteens-and-young-adults/the-truth-about-suicide-realstories-of-depression-in-college
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Implications For School And Mental
Health Professionals
 Suicidal intent must be assessed with any
student who engages in self-harming
behavior.
 If there is a bleeding or seeping wound the
nurse/medical staff should evaluate and treat.
 Contagion may play a factor in the increase in
the number of students who self-injure.
 The media, internet, videos and music are
mediums for school personnel to monitor.
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What Is The School’s Response?
 Include self-harming behaviors in policies on
student safety.
 Establish procedures for school personnel to
follow in identifying, reporting, monitoring and
supporting youth who self-harm in and out of
school.
 Conduct annual crisis response training for
appropriate staff reviewing 302 procedures,
utilizing Act 147, and intervening with student’s
who experience safety concerns.
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What Is The School’s Response? (cont’d)
 In-service all staff on the
 Include the School Nurse
nature of self-harming
behaviors.
 Inform parents of at-risk
behaviors including SIB.
 Utilize the Student
Assistance Program.
 Know your personal and
professional limits when
intervening.
in the evaluation of any
wound/injury.
 Involve parents through
out the intervention and
management of the
student.
 Obtain releases with
clinician to share info. &
treatment strategies.
 Consider need for 504
accommodations.
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Recommended Policies and Procedures for
Schools
 302 Procedures for students who can not keep




themselves safe
Comprehensive suicide prevention programs focusing
on students, staff and parents addressing mental
health awareness, appropriate interventions, and
resources
Postvention procedures in the event of a suicide or
other tragic loss
Memorial policy
Visit www.starcenter.pitt.edu for sample policies and
procedures
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Youth Mental Health Issues Impact on the
Family
 Changes in routines for the family
 Increased anger, frustration and irritability
 Guilt and blame among family members
 Shame and resentment about the illness
 Anxiety and fear about the illness
 Feeling the need to “walk on eggshells” around
the depressed person
 Mental health issues of other family members
may become more apparent
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Approaching Parents
 Voice concerns and observations.
 Educate parents about self-injuring
behaviors.
 Address concerns of parents.
 Assist with referrals for evaluation,
treatment, crisis and support .
 Collaboratively plan with teen, family and
mental health provider.
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What To Do If You Suspect A Youth Has
Mental Health Issues
 SEEK HELP from a mental health professional
 ENCOURAGE teen to follow his/her treatment
plan
 BE PATIENT – most mental health issues are
very treatable but results are often gradual
 EXPLORE support resources for the child at
school and community
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https://www.youtube.com/watch?v=EBS0YggSTTo&list=PL319B
8A8394A65757
102
Skills to Help Teens Decrease Self
Injury: Refer to STAR Manuals
 Emotion Education
 The Freeze Frame Technique
 Emotion Regulation Skills
 Distress Tolerance
 Sensory Soothing
 Communication Skills
 Download “Emotional Regulation, Distress
Tolerance and Interpersonal Skill Development”
manual at www.starcenter.pitt.edu
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If the student has given any
verbal or behavioral indicators of
self-harm or harm to others,
follow your school or agency
crisis plan!
If there is a crisis situation. . .
 Be familiar with 302 procedures or
know how to reach who does.
 Keep the student near you.
 Keep the student talking.
 Reach the student’s parents.
 Limit contact with other teens.
Developed by Dr. Mary Margaret Kerr
1. If the student hesitates, gently offer an
example of the worrisome behavior.
“You seem to have lost your interest in the
track meet.”
“I’ve noticed that you seem more excited
than usual.”
“You look as if you have dropped a lot of
weight recently.”
“I notice you’ve been sleepy a lot lately.”
2. Resist the urge to explain the symptom
and/or offer advice.
Don’t say. . .
“I guess your track team is not doing as well
this year. No wonder you’re less excited.”
“Maybe you should eat more.”
“Kids sometimes sleep too much when
they’re bored. Maybe you need to……”
3. Be a good listener so the
student feels comfortable
talking.
Pay attention to how much you
are actually listening versus
counseling.
4. Do not badger!
Here are some ways we badger:
“I took time to talk with you, and this is all you
have to say?”
“Why don’t you face facts; something is wrong
with you.”
“If you don’t want help now, then don’t come to
me later.”
“Stop making excuses and get your work done.”
5. If the student does not want to talk, try
another option.
“Maybe this isn’t a good time. We could meet
after school.”
“I know you and Dr.. Robb are close. Do you
feel you might want to talk with him? I can
check to see when he is available.”
“If you ever want to talk, just let me know.”
“Sometimes students are more comfortable
expressing their problems in writing. Would
that make things easier for you?”
6. Be patient!
Students with problems are not always
articulate. It may take a little while for
them to explain how they feel.
Do not interrupt.
Show the student that you are interested
by looking at him and nodding your head.
7. Avoid Judgments.
This is no time to evaluate the student’s
perceptions.
“Well, that is nothing to worry about.”
“How did you ever get into such a mess anyway?”
“I hope you learned your lesson.”
8. Next, name some action that you can take
with the student.
If you cannot immediately think of a plan, at least
show your acceptance and willingness to help.
“I am not sure how to tackle this problem, but we
can think it through.”
“Gee, his is a real problem. Let me give it some
thought. We’ll talk Wednesday, okay?”
“Now I see. How about if I share some of this with
the counselor? I think she could help.”
“I’d like to help you through this. How would you
like to proceed?”
Some students need information to view their
situations more hopefully. If this is the case, offer
it.
“I see why you were so worried about this quiz. You
did not realize that everyone did poorly. I have
decided to adjust everyone’s grades.”
“Suspension is serious, but no, it does not mean you
fail the course.”
“I know the seniors said they could vote you off the
team, but that decision is made only by the coach.”
Additional Talking Points…
9. Close the conversation with reassurance – even if
you can not genuinely show acceptance of the
student’s views.
10. Follow up on your commitment to seek help on
behalf of the student. This will most likely involve
a member of the crisis/SAP team and the
parent/guardian.
11. Know the limits of your confidentiality and be
honest with the student.
Specific Guidelines for Talking
with a Suicidal Teen
Remember the
“SAD ADOLESCENT”
Mnemonic tool developed by Dr. Mary
Margaret Kerr
Remember the “SAD ADOLESCENT:
 Sex – females more likely to attempt, males more likely
to choose more lethal means
 Age - 15 – 24 most at risk among youth
 Depression – a major risk factor especially if untreated
 Availability of means – especially firearms in the home
but suffocation nearly as often
 Discord in family or parent mental health issues
The “SAD ADOLESCENT” cont.
 Organized - plan/intent/prepared
 Do not hesitate to ask about suicidal
thoughts and plans.
 Be gently persistent in seeking details about
suicidal thoughts.
 Ask about frequency, duration, and intensity
of these thoughts.
 Lack of social supports – loss of friends; peer
conflicts
The “SAD ADOLESCENT” cont.
 Earlier suicide ideation or attempts
 Do not hesitate to ask about previous
suicide attempts.
 Substance abuse or chemical dependency
– especially an increased use
 Cognitive distortions, hopelessness,
perceived burdensome
The “SAD ADOLESCENT” cont.
 Not agreeable to a safety plan to keep from acting
upon suicidal thoughts. Safety plan involves:
 Youth agreeing not to act on suicidal thoughts
 Identifying distraction strategies that involve others and
those that involve no one else
 Identify trusted adults they will call if the thoughts
become urges and they are in distress
 Numbers of crisis contacts
 Identifying triggers and reviewing the plan with the
youth’s parents/guardians
 Temper, aggression, homocidality
How to help:
Know warning signs and what your
can do or who you can tell.
Be familiar with local and national
resources.
Offer hope and follow up.
Maintain and model your own selfcare.
2013-14 Student PSA Winners
 Posters, 30 and 60 second audio and video PSA
 Needed faculty sponsor and follow media guidelines on
reporting on suicide
 http://www.nimh.nih.gov/health/topics/suicideprevention/recommendations-for-reporting-onsuicide.shtml
 Review winners at:
http://payspi.org/news-and-events/2013-psa-contest/
http://payspi.org/news-and-events/2014-psa-contest/
Aevidum Club founded at Calico High School
 If depression were as easy to spot in the hallway as a
banana… www.aevidum.com
Re-enforcing Healthy Stress Reduction and
Symptom Mitigating Strategies
 Educate student on connection between their
lifestyle and their stress symptoms
 Many stress reactions can be mitigated by self
management choices
 Many stress management techniques can have an
impact if they are only visualized e.g. taking a bath,
sitting at the beach
 Each student needs their own “bag of tricks”
 Refer to handout - H.E.A.R. M.E. and Improving
Sleep
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Self-Soothing Through the Five Senses
 Accessible and easily taught self-
soothing/distress tolerance skills is to use
the 5 senses
 Vision, hearing, smell, taste, touch
 Usually at least 2-3 of the five senses are
engaged or capable of being engaged at any
given moment as a distraction from distress.
 “Observe, Describe and Experience”
Life isn’t the way it is
supposed to be. Life is the
way it is. It is how we cope
that makes the difference.
Anonymous Adolescent
127
P.S. The answers are all true and
exhaling is a great start to self-care!
128
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geese+video&FORM=VIRE4#view=detail&mid=085FF
F79D23D16B935A0085FFF79D23D16B935Ao
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Key Resources
 AFSP – American Foundation for Suicide Prevention
www.afsp.org
 PAYSPI – Pennsylvania Youth Suicide Prevention
Initiative www.paspi.org
 SPRC – Suicide Prevention Resource Center
www.sprc.org
 SAMHSA – Substance Abuse and Mental Health
Services Administration (US DEPT of Health and
Human Services) http://captus.samhsa.gov/accessresources/preventing-suicide-toolkit-high-schools
Key Resources
 Maine Youth Suicide Prevention Program
www.maine.gov/suicide/docs/guideline.pdf
 National Action Alliance for Suicide Prevention
http://actionallianceforsuicideprevention.org/
 National Suicide Prevention Lifeline
 www.suicidepreventionlifelide.org
 1- 800 – 273-TALK
College Resources
 The JED Foundation – a nonprofit public charity
committed to reducing youth suicide and improving the
mental health safety net for college students:
 http://www.jedfoundation.org
 Ulifeline – Among other programs, The Jed Foundation
created Ulifeline, an anonymous Internet based resource
that provides students with a supportive link to their
college mental health or counseling center:
 http://www.ulifeline.org
132
Selected Resources
 Aevidum – www.aevidum.com
 Suicide Prevention Resource Center –
www.sprc.org
 Safety Planning Guide for Clinicians
and Template
http://www.sprc.org/sites/sprc.org/files/Safet
yPlanningGuide.pdf
http://www.sprc.org/sites/sprc.org/files/Safet
yPlanTemplate.pdf
133
Selected Resources (cont.)
 Cornell Research Program on Self-Injurious
Behavior in Adolescents and Young Adults
 http://crpsib.com/factsheet_aboutsi.asp
 National Institutes of Mental Health
 http://www.nimh.nih.gov
 National Center for the Prevention of Youth
Suicide
 http://www.suicidology.org
134
References
 American Psychiatric Association. (2003) Practice
guidelines for the assessment and treatment of
patients with suicidal behavior. Am J Psychiatry,
160(11): 1 – 60.
 Brent DA, Poling KD, Goldstein TR (2011). Treating
depressed and suicidal adolescents. New York:
Guilford Press.
 Goldstein TR and Poling KD (2011). SIB Institute,
STAR Conference, Pgh., PA
 Hayes, L. (2009) Juvenile suicide in confinement: A
national survey. US Dept. of Justice, OJJDP.
Download at www.ncjrs.gov/pdffiles1/213691.pdf
135
References (cont.)
 Kaffenberger & Seligman (2007). Helping
students with mental and emotional
disorders, In Erford (ed.)Transforming the
school counseling profession(2nd ed.),351-383,
Upper Saddle River, NJ: Pearson.
 Lewis Lm. (2007). No-harm contracts: a
review of what we know. Suicide Life Threat
Behav.,37,50-57.
136
References (cont.)
 Peterson et al., (2010). Adolescents who
harm: How to protect them from themselves.
Current Psychiatry, 9, 15-26.
 Spirito A & Overholser J, editors (2003).
Evaluating and treating adolescent suicide
attempters. San Diego, CA: Elsevier Science.
 Wexler DB (1991). The adolescent self:
Strategies for self-management, selfsoothing, and self-esteem in adolescents.
New York, NY: Norton and Co.
137
Selected Resources
 National Suicide Prevention Lifeline
 http://www.suicidepreventionlifeline.org/
 1-800-273-TALK
 Suicide Prevention Resource Center –
www.sprc.org
 Safety Planning Guide for Clinicians and
Template
http://www.sprc.org/sites/sprc.org/files/SafetyPlanning
Guide.pdf
http://www.sprc.org/sites/sprc.org/files/SafetyPlanTemp
late.pdf
138
Selected Resources (cont.)
 Cornell Research Program on Self-Injurious
Behavior in Adolescents and Young Adults
 http://crpsib.com/factsheet_aboutsi.asp
 National Institutes of Mental Health
 http://www.nimh.nih.gov
 National Center for the Prevention of Youth
Suicide
 http://www.suicidology.org
139
STAR-Center Resources
 STAR-Center website
 http://www.starcenter.pitt.edu
 Manuals include:
Dialectical Behavior Therapy with
Teenagers
Managing Anxiety
Living with Depression
Teenage Depression
Postvention
140
Life isn’t the way it is
supposed to be. Life is the
way it is. It is how we cope
that makes the difference.
Anonymous Adolescent
141
This presentation was developed by Services for
Teens At Risk and may not be reproduced
without written permission from:
STAR-Center Outreach, Western Psychiatric
Institute and Clinic, 3811 O’Hara Street, Pgh., PA 15213
(412) 864-3346
All Rights Reserved, 2005, 2009, 2013, and 2014.
142