Suicide Prevention in Schools

According to the CDC, suicide is the second leading cause of death for children, adolescents, and young adults ages 10-24, only after accidents (2018).  The period between childhood and adulthood is a time of major changes in an individual's body, thoughts, and feelings. 

  • The Youth Risk Behavior Surveillance Survey found that 17% of high-school-aged youth seriously considered suicide in the previous 12 months and 8% made one or more attempts within the same time period (CDC, 2018).
  • Rural youth are at particularly high risk of suicide, with suicide rates approximately double those in urban areas (Fontanella, et al., 2015).
  • Firearms remain the most common means of death for youth, with firearms used in more than 50% of suicides (CDC, 2018). Death by suffocation, particularly hanging, is also common and is the leading cause of death by suicide in children under 12 (Sheftal et. al., 2016).
  • In general, youth with frequent and severe suicidal ideation (i.e. high levels of intent and/or planning) have about a 60% chance of making a suicide attempt within 1 year of ideation onset (Goldstein, 2009).

1 in 5 college students have had thoughts of suicide, with 9% making an attempt and nearly 20% reporting self-injury (Lui et al., 2018).

Suicide Prevention Pathway for School Settings

Based on the statistics, schools are a key setting for suicide prevention. Teachers, mental health providers, and all personnel who interact with students are in a unique position to keep students safe and reduce suicide risk and suicide deaths. A comprehensive approach is needed to promote the emotional well-being of students, identify students at risk for suicide, and create pathways to respond when suicide risk is identified or a suicide death occurs. It is important to remember that students in elementary school, middle school, high school, and colleges and universities are all in different phases of life, although the suicide risk among all of them is high. Using age-appropriate language and prevention strategies is important.

Risk and Protective Factors for Suicide Among Students

There are a number of unique suicide risk factors among youth and adolescents, including previous suicide attempts, isolation and withdrawal, mental health conditions (i.e. anxiety, depression, conduct disorders), childhood maltreatment, bullying, mood changes, losses (i.e. breakup, lost friendships, academic failure), and self-injury.

Some Important Risk Factors for Suicide: History of Substance abuse; physical disability or illness; losing a friend or family member to suicide; ongoing exposure to bullying Behavior; mental health condition; recent death of a family member or a close friend; access to harmful means; relationship problems; previous suicide attempts Protective Factors: parent connectedness; connections to other non-parental adults; school safety; closeness to caring friends; overall resilience; neighbourhood safety; awareness and access to local health services; academic achievement

What school districts can do:   It is critical for school districts to have policies and procedures in place to prevent, assess, intervene, and respond to suicidal behavior among children, adolescents, and young adults (Moutier et al, 2019).

This model includes discussion around appointing a district-level suicide prevention coordinator, staff professional development and training, suicide prevention curriculum, intervention, parental notification, and action plans for each step of the suicide prevention pathway.

What schools can do:   Schools can improve their suicide prevention by familiarizing themselves with legislation in the state requiring suicide prevention, ensuring their school has a comprehensive suicide prevention policy in place, requiring annual training for all staff, providing mental health presentations for parents and students, and even creating a suicide prevention task force or assigning a suicide prevention expert at their school (Safe Schools, 2020). Schools can also post information around their building about suicide warning signs, who to contact at the school if you know someone is suicidal, and national crisis hotline numbers (Safe Schools, 2020).

The role of mental health providers:   School-based mental health services are typically provided by school counselors, school psychologists, and school social workers that are specifically trained in school system functioning and learning, as well as how students’ behavior and mental health impacts their ability to be successful. (NASP, 2016) These important mental health providers have the critical role of addressing suicide and determining next steps for student safety and treatment. It is crucial that these providers have adequate training in suicide assessment and intervention so that they can provide expertise, support, and information to teachers, staff, students, and parents who may notice a student is struggling (SPRC, 2019). Mental health providers should also maintain a list of resources for teachers, students, staff, and parents including tools, support, training and skills for addressing and preventing suicide within their school.

The role of teachers:   Teachers are well-positioned to promote the emotional and social well-being of all their students. Teachers have daily contact with students, some of whom have problems that could result in serious injury or even death by suicide (SPRC, 2019). Teachers should be paying close attention to what students say, do, and write, and be prepared to act when they suspect a student may be at risk for suicide (SPRC, 2019). In addition, teachers should be trained on the risk factors and warning signs that increase suicide risk (mental health disorders, substance use, family history, access to lethal means, exposure to the suicide of another person, stress, etc.). Teachers are also able to advocate for and support school-wide programs for suicide prevention, postvention, suicide screening of students, parent education, and staff education and training. 

What Parents Can Do:

Parents and legal guardians play an important role in suicide prevention for their school-aged children. Parents should know and look for risk factors and warnings signs for suicide among their children. Another practical suicide prevention tactic is ensuring safe storage of firearms in the home. Research shows that firearms are the primary method used in teen suicides, while in elementary-school aged children, hanging is used most often. 1    Removing access to lethal means for individuals at risk for suicide should be a top priority for the individual’s family or guardians, as research shows that 80% of guns used in youth suicide belonged to a parent. 2   Parents or guardians of the patient should monitor other lethal means as well, such as access to materials for hanging/suffocation (belts, ropes, or other items) or large quantities of high-risk medications.

In Montana, many students take a hunter safety course as part of their school curriculum or outside of school. Parents should make sure they have a discussion with their children about firearm use and safe storage of firearms.

Training

The goal of training within schools for teachers and staff is to help them identify students at risk for suicide and provide them with the knowledge of actionable steps to take once students have been identified.

Mental Health First Aid:

Mental Health First Aid (MHFA) is a skills-based training that teaches participants how to help someone who is developing a mental health problem or experience a mental health crisis. This training covers risk factors and warning signs, information on depression, anxiety, trauma, and addiction, action plans to help someone, and where to turn for professional and self-help. MHFA is beneficial for all ages and all roles in school settings and the community, including teachers, students, parents, and even school safety officers.

  • Youth Mental Health First Aid  is designed to teach parents, family members, caregivers, teachers, school staff, peers, neighbors, health and human services workers, and other caring citizens how to help an adolescent (age 12-18) who is experiencing a mental health or addictions challenge or is in crisis.

  • Mental Health First Aid in Schools  introduces adults to the unique risk factors and warning signs of mental health problems in adolescents, builds understanding of the importance of early intervention, and teaches individuals how to help youth in crisis or experiencing a mental health challenge.

  • Mental Health First Aid for Higher Education  teaches students, professors and other school faculty how to notice and respond to mental health and addiction challenges commonly experienced by youth in higher education settings.

  • Teen Mental Health First Aid  is an in-person training that teaches high school students about common mental health challenges and what they can do to support their own mental health and help a friend who is struggling. 

  • Mental Health First Aid for Public Safety   provides law officers and staff with more response options to help them de-escalate incidents and better understand mental illnesses so they can respond to mental health-related situations appropriately without compromising safety.

ACT on FACTS Training

ACT on FACTS Training  is a two-hour online training addresses the critical but limited responsibilities of educators in suicide identification and prevention, the realities and challenges inherent in the school setting, risk and warning signs, populations at increased risk, and strategies for handling at risk students.

Applied Suicide Intervention Skills Training (ASIST)

Applied Suicide Intervention Skills Training (ASIST) is a longer, two-day training designed for all caregiving groups. This training is often used in school settings for teachers and staff to ensure they are prepared to provide suicide care to their students. This training emphasizes suicide first aid, seeking help from other professionals as needed, developing a plan for suicide prevention, and partnering with suicide-safer community networks.

Suicide Prevention: A Gatekeeper Training for School Personnel

A Gatekeeper Training for School Personnel  is a two-hour training covers the scope of the suicide problem, basic suicide facts, warning signs, risk and protective factors, ways to ask students about suicidal thoughts and behaviors, and ways to help students who may be struggling and need access to resource.

QPR Institute

The QPR Institute offers a variety of trainings in suicide prevention. The   QPR Gatekeeper Training  covers how to Question, Persuade, and Refer someone who may be at risk for suicide, common causes of suicidal ideation, how to get help for someone in crisis, and the warning signs of suicide.

 In addition to the Gatekeeper Training, there are a number of supplemental training resources.

  • QPR for School Health Professionals : This online course should be useful to all social workers, psychologists, nurses, and counselors, and teachers who may find themselves in the role of identifying and assisting troubled youth, but not tasked with conducting a full suicide risk assessment intervention.

Signs of Suicide (SOS) Student Training

SOS  is a universal, school-based program intended for use among middle (ages 11-13) and high school students (ages 13-17). The goals of the program are:

  • Decrease suicide and suicide attempts by increasing student knowledge and adaptive attitudes about depression
  • Encourage personal help-seeking and/or help-seeking on behalf of a friend
  • Reduce the stigma of mental illness and acknowledge the importance of seeking help or treatment
  • Engage parents and school staff as partners in prevention through “gatekeeper” education
  • Encourage schools to develop community-based partnerships to support student mental health

Intervention

Despite the prevalence of suicide in youth and young adults, it can often go undetected. Most preventive suicide screening programs have not been scientifically evaluated or have yielded mixed results.

  • If your school has a mental health professional on site or available to be on site, this is one opportunity for suicide screening to take place.
  • If you do not have a mental health professional on site at your school, a referral should be made for screening and assessment to occur with an outside source. This referral should be a warm handoff, be tracked and followed up on to ensure that the connection occurred. There should be a written plan for this student that delineates each provider’s role in the care of this at-risk student.

There are a number of screening tools that have been created or adapted for children, teens, and adolescents that can assist in the identification of suicide risk. One example of a screening tool for youth is ASQ (Ask Suicide Screening Questions).  

What Schools Can Do After a Suicide

Along with creating a comprehensive suicide prevention plan, it is important to have a concrete plan in place to respond if a suicide occurs in your community. The death of student by suicide will inevitably leave a school faced with grieving students, distressed parents and school staff, and a community struggling to understand how it happened (SPRC, 2019). Schools need to be prepared with information, tools, and guidance to protect and communicate with their students. The Suicide Prevention Resource Center created a detailed toolkit titled “ After a Suicide: A Toolkit for Schools.” One key component of this toolkit that is crisis response.

Crisis Response: After confirming the death of a student, schools should ensure they have a coordinated crisis response plan in place that includes grief support, maintenance of normal educational activities as possible, coping resources, and how to minimize the risk of “suicide contagion.”

If your school does not have a Crisis Response Team in place, it is recommended that your school review the   Crisis Action School Toolkit on Suicide  (CAST-S). The CAST-S is designed to assist school personnel in Montana to implement the required legislation and is not intended to be a substitute for training. Crisis response protocols are essential when students are detected as suicidal to provide a standardized response to safeguard students and protect schools from liability. The Tools section of the CAST-S outlines recommendations for training and crisis-action protocols for responding to suicidal students, notifying their parents, documenting all actions, and recommending needed supervision and services for the suicidal students. A Crisis Response team should generally include a combination of administrators, counselors, social workers, psychologists, nurses, and other resource officers. A Crisis Team Coordinator, usually the principal or another administrator, should be assigned to be responsible as the central point of contact and to monitor postvention activities. If the cause of death is not confirmed or the family does not want to disclose the cause of death, it is important to have a conversation with the family of the student before disclosing any information about the death. If the family refuses to share the cause of death, here is a way to channel that information into suicide conversations in a different way.

“We know there has been a lot of talk about whether this was a suicide death. Since the subject of suicide has been raised, we want to take this opportunity to give you accurate information about suicide in general, ways to prevent it, and how to get help if you or someone you know is feeling depressed or may be suicidal.”

More details on activities and tasks of various staff members in response to a student suicide can be found in this toolkit:

  • Helping Students Cope:   It is important for schools to provide opportunities for students to express their emotions and learn how to manage them. If there are concerns about the mental or emotional health of a student, a referral should be made to a mental health professional or assessment. Further details on how to conduct therapy or group sessions, practical coping mechanisms to share with students, and how to outreach to parents can be found in the toolkit linked above.
  • Working with the Community:   Schools exist within the context of a larger community, so it is important to establish and maintain open communication and working relationships with community partners before and after a suicide. Some of these partners can include mental and health care professionals, funeral directors, police, community-based agencies, and a medical coroner. This communication may include offering relevant information about the death, any ongoing investigations, revelations about a larger community-wide problem, linkages to mental health and health care resources and services, etc.

Other Resources

  • Montana Crisis Action School Toolkit on Suicide (CAST-S):   The CAST-S contains items for schools within Montana to address suicide, including: social media guidelines.
  • PAX Good Behavior Game : The PAX Good Behavior Game is an environmental intervention used in the classroom with young children to create an environment that is conducive to learning. The intervention is designed to reduce off-task behavior, increase attentiveness, and decrease aggressive and disruptive behavior in addition to shy and withdrawn behavior. The intervention also aims to improve academic success, as well as mental health and substance use outcomes later in life.
  • Youth Aware of Mental Health  (YAM):   A school-based intervention for youth ages 13-17 in which they learn about and discuss mental health.
  • New York State   Guide for Suicide Prevention in New York Schools

 

References:

  1. Liu et al, 2018.  onlinelibrary.wiley.com/doi/abs/10.1002/da.22830
  2. Moutier, et al. 2019.   https://www.datocms-assets.com/12810/1576931010-13820afspmodelschoolpolicybookletm1v3.pdf
  3. Safe schools, 2020.   https://www.safeschools.com/hot-topics/youth-suicide-prevention/
  4. https://www.nasponline.org/resources-and-publications/resources-and-podcasts/mental-health