September is Suicide Prevention Awareness Month

Youth Suicide

In Schools, Mental Health Should Be Everyone’s Responsibility

Background

In the last decade, suicide has jumped from being the third to the second leading cause of death for youth between 10 and 24 year olds. The Centers for Disease Control (CDC) and Prevention reports that approximately 4,600 lives are lost each year—and that suicide among teens and young adults has nearly tripled since the 1940s. There is no argument that youth suicide is a serious, yet preventable public health problem.

More than 90 percent of people who die by suicide have a treatable mental illness such as depression, bipolar disorder, schizophrenia, personality disorder, anxiety disorder (including posttraumatic stress disorder and panic attacks), eating disorders, and/or alcohol and substance abuse. According to the 2011-13 California Healthy Kids Survey (CHKS) (table below), 25.3 percent of 7^th graders and 30.7 percent of 9^th graders in the state reported having extended feelings of sadness/hopelessness. The highest percentage was found among non-traditional students at 32.5 percent. Tragically, only less than 20 percent of children and adolescents with diagnosable mental illnesses receive needed treatment, according to the National Alliance on Mental Illness.

http://chks.wested.org/indicators/66/depression-related-feelings-student-reported-by-grade-level/

Youth suicide prevention is an important, but often overlooked, unaddressed topic in Kindergarten through Twelfth (K-12) grade schools in our state. California’s suicide rates are below the national average, however, they are alarming nonetheless. In 2013, 29 children ages 5-14 and 150 youth ages 15-19 in California were known to have died by suicide.  These were school-aged children attending public and private schools in California. These children attending school were most likely showing signs of emotional distress but the “signs” went unnoticed by those that spent the most time with them. This is proof that the California educational system must improve in addressing the mental health needs of students. Providing school staff with the skills to identify, refer, and support those students that may be struggling with a mental illness is a good start. Intervening doesn’t guarantee that a person won’t complete suicide. However, knowing the signs of depression and other mental illnesses as well as the risk factors could help you to intervene early and save a life.

Each of these youth suicides impacted more than the families of the youth. The lives of their classmates, teachers, administrators, peers, other school staff, and communities all felt the effect of their suicide. Unfortunately, most schools do not have policies, protocols or administrative regulations in place to prevent youth suicide or address the postvention. Currently, there is pending legislation (Assembly Bill 2246 https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB2246 ) that would require school districts to adopt suicide prevention policies administrative regulations.

According to the CDC, there is one suicide for every 25 attempted suicides. This means that for every youth who dies due to suicide, there are many more who think about, plan, or attempt suicide. This is indicative that the problem of youth suicide is far deeper than the rare occasion of death by suicide. Learning to pay attention to the “warning signs” and risk factors that put young people at a higher risk for suicide is critical for school staff.

The 2011-13 CHKS (table below) revealed that 19.3 percent of 9^th graders and 17.5 percent of 11^th graders in California had seriously considered attempting suicide in the past 12 months. This data indicates that we must begin to take suicide prevention more seriously.

http://chks.wested.org/indicators/153/seriously-considered-attempting-suicide-in-the-past-months-by-grade-level/

With the many responsibilities of school staff, it is no wonder that mental health is often not on their list.  However, this fundamental base is critical to the success of students and must be addressed at every level in schools by all staff members. We can no longer deny how mental wellness contributes to the academic success. Most students who are emotionally distressed do not fare well in school. Their grades and relationships with peers and teachers suffer. These strained relationships and poor grades compound

Adolescence is a time of dramatic growth and development. It is a period full of physical, mental, emotional, and social changes.  There are hormonal changes, mood swings, questioning authority, intense feelings, and peer influence. Youth tend to think their current situation is permanent. Most youth are resilient and they go through adolescence with relatively little difficulty despite all of the challenges. Many times, it is difficult to determine if these changes are developmentally appropriate or if they could be signs of mental illness.

Suicide affects all youth, but some groups are at higher risk than others. Boys are more likely than girls to die from suicide, but females are more likely to report attempting suicide. Among racial/ethnic groups nationwide, American Indian/Alaska Native youth have the highest suicide rates. Research also shows that lesbian, gay, and bisexual youth are more likely to engage in suicidal behavior than their heterosexual peers. Several other factors put teens at risk for suicide, including a family history of suicide, past suicide attempts, mental illness, substance abuse, stressful life events, low levels of communication with parents, access to lethal means, exposure to suicidal behavior of others, and incarceration. However, having these risk factors does not always mean that suicide will occur.

Data collected from the 2011-13 CHKS depicts (table below) the difference between gender and grade level in those that had seriously considered attempting suicide in the past 12 months.

Some groups are at a higher risk for suicide than others. Males are more likely to commit suicide, but females are more likely to report attempting suicide (1, 2). Among racial/ethnic groups nationwide, American Indian/Alaska Native youth have the highest suicide rates (1, 2). Research also shows that lesbian, gay, and bisexual youth are more likely to engage in suicidal behavior than their heterosexual peers (6). Several other factors put teens at risk for suicide, including a family history of suicide, past suicide attempts, mental illness, substance abuse, stressful life events, low levels of communication with parents, access to lethal means, exposure to suicidal behavior of others, and incarceration (1, 2). Some groups are at a higher risk for suicide than others. Males are more likely to commit suicide, but females are more likely to report attempting suicide (1, 2). Among racial/ethnic groups nationwide, American Indian/Alaska Native youth have the highest suicide rates (1, 2). Research also shows that lesbian, gay, and bisexual youth are more likely to engage in suicidal behavior than their heterosexual peers (6). Several other factors put teens at risk for suicide, including a family history of suicide, past suicide attempts, mental illness, substance abuse, stressful life events, low levels of communication with parents, access to lethal means, exposure to suicidal behavior of others, and incarceration (1, 2). Some groups are at a higher risk for suicide than others. Males are more likely to commit suicide, but females are more likely to report attempting suicide (1, 2). Among racial/ethnic groups nationwide, American Indian/Alaska Native youth have the highest suicide rates (1, 2). Research also shows that lesbian, gay, and bisexual youth are more likely to engage in suicidal behavior than their heterosexual peers (6). Several other factors put teens at risk for suicide, including a family history of suicide, past suicide attempts, mental illness, substance abuse, stressful life events, low levels of communication with parents, access to lethal means, exposure to suicidal behavior of others, and incarceration (1, 2).

http://chks.wested.org/indicators/154/seriously-considered-attempting-suicide-in-the-past-months-by-gender-and-grade-level/

Warning Signs:

• Excessive sadness or moodiness: Extended sadness, extreme mood swings, being anxious, agitated, unexpected rage, and/or seeking revenge.
• Hopelessness: Feeling sense of hopelessness, no reason for living or no sense of purpose in life.
• Sleep Sleeping too little or too much.
• Feeling trapped. Having little expectation that circumstances can improve.
• Sudden calmness: Suddenly becoming calm after a period of depression or moodiness can be a sign that the person has made a decision to end his or her life.
• Withdrawal: Withdrawing from friends, family, or society, including loss of interest/pleasure in activities the person previously enjoyed.
• Changes in personality and/or appearance: change in attitude or behavior, such as speaking or moving with unusual speed or slowness; sudden disinterest about his or her personal appearance.
• Dangerous or self-harmful behavior: Reckless driving, unsafe sex, and increased use of drugs and/or alcohol.
• Recent trauma or life crisis: A major life crises might trigger a suicide attempt.
• Making preparations: Giving away prized possessions, saying goodbye.
• Threatening suicide: Every threat of suicide should be taken seriously.

https://afsp.org/about-suicide/risk-factors-and-warning-signs/

What Can Schools Do?

School staff must:

• Acknowledge that youth suicide is a serious public health problem in which schools have a robust role.

• Recognize that suicidal thoughts can happen as early as 5 years old and that elementary schools must also have suicide prevention plans.

• Be cognizant of the fact that students can be high functioning and experience depression or other mental disorders.

• Know that talking about suicide or asking a student if he/she is contemplating suicide will not encourage suicide.

• Know that your words can have a positive or negative impact on a student’s day.

• Understand there is no typical suicide victim. Youth of all ethnicities, social-economic backgrounds, religions, etc. attempt or complete suicide.
• Youth don’t necessarily want to die, they want the pain to stop.

Create a Positive School Climate

Suicide prevention begins with strategies to promote a positive school climate that fosters healthy, respectful relationships among students, staff, and parents/guardians/caregivers and strengthens students’ feelings of connectedness to their school.

Essential to positive school climate are discipline policies and programs that focus on keeping students in school and learning, while providing the tools and opportunities they need to succeed through strategies such as Restorative Justice and Positive Behavioral Intervention and Supports (PBIS).

Each school’s Comprehensive School Safety Plan should promote the healthy mental, emotional, and social development of students. Mental health education should be included in any health class in the school curriculum to enhance students’ understanding of mental health issues through social-emotional learning.

The superintendent or a designee should be responsible for reviewing each school’s Comprehensive School Safety Plan and for the implementation of the district’s suicide prevention policy and administrative regulations. The superintendent or a designee should encourage schools to incorporate student input in any plans for improving school climate or preventing suicide. School climate surveys, with input from students, parents/guardians/caregivers, and the entire school community are essential to assess a school’s strengths and areas of greatest need at the outset, as well as to determine whether improvement efforts are having an impact.

School climate improvement can be a strong contributor to suicide prevention, but it must be an integral component of all school improvement efforts (including all Local Control and Accountability Plans), with strong leadership, guidance, and schoolwide commitment.

Provide Staff Development

Staff training for student mental health and suicide prevention and postvention should be provided and be designed to help staff identify and respond to students who are at risk, beginning with a survey to determine current knowledge, attitudes, and beliefs regarding student mental health.

The training should be offered under the direction of a school counselor, school social worker, school psychologist, or in cooperation with one or more community behavioral health agencies. The training should include the following methods of suicide prevention:

1. Recognize warning signs that may indicate suicidal ideation, including changes in a student’s appearance, personality, or behavior.

2. Understand potential risk factors for students, such as: exposure to trauma, previous attempts to harm/injure themselves, abuse in the family, history of depression or mental illness, substance abuse problems, family history of suicide or violence, feelings of isolation, being bullied or bullying, interpersonal conflicts, a recent severe loss, or family instability.

3. Use research-based instructional strategies to teach suicide prevention and postvention curriculum and promote mental and emotional health.

4. Develop an inventory of community resources and services that are available for referral.

5. Disseminate district procedures for the appropriate interventions to use when a student attempts, threatens, or expresses thoughts about committing suicide.

6. Cultivate annual opportunities for student involvement, such as the National Alliance on Mental Illness (NAMI) on Campus High School Clubs http://namica.org/programs/education/nami-on-campus/nami-on-campus-high-school/, NAMI Ending the Silence http://www.nami.org/Find-Support/NAMI-Programs/NAMI-Ending-the-Silence, Sources of Strength https://sourcesofstrength.org, My3App http://www.my3app.org, Walk in Our Shoes http://walkinourshoes.org, Directing Change http://www.directingchange.org, and other related programs and resources.

7. Ensure that all staff are included in training. Veteran staff will need “refresher” training and new teachers and other staff will need an “orientation” training.

The training also may coincide with discussions regarding the role of school staff as mandated reporters.

Implement Intervention Strategies

Whenever a staff member suspects or has knowledge of a student’s suicidal ideation, he/she will promptly notify the principal or a designated school counselor or school social worker. The principal, school counselor, or school social worker then should  notify the student’s parents/guardians/caregivers as soon as possible and may refer the student to mental health resources in the school or community.

Students should be encouraged to notify a teacher, principal, school counselor, school social worker, or other adult when they are experiencing thoughts of suicide or when they suspect or have knowledge that another student is considering suicide.

Establish Suicide Prevention Procedures

The governing board of each district should direct the superintendent or a designee to establish crisis intervention procedures to ensure student safety and appropriate communications at the district level in the event that a suicide occurs or an attempt is made on campus or at a school-sponsored activity. Incidents that are not school-related may also have an impact on students and should be considered as well.

The goals of postvention include supporting the survivors, preventing imitation suicides by identifying other individuals who are at risk for self-destructive behavior, avoiding sensationalism, avoiding glorifying or vilifying of suicide victims, managing the message shared with other students, and referring any student who is at risk to intervention services.