1. Bullying and Youth Suicide Prevention Judith Springer, Psy. D. Clinical and Professional Board Member, SPTS

2. Provide basic information about suicide and suicide prevention.  Discuss relationship between suicide prevention and bullying prevention.  Define educators’ crucial, although limited, role in schools’ suicide prevention efforts Review the roles of parents and students in suicide prevention. Workshop Objectives

3. Each year, Each day Every 2 hours and 11 minutes one person under the age of 25 completes suicide. Each year, there are approximately 10 youth suicides for every 100,000 youths in the United States. Each day, there are approximately 11 youth suicides in our country. Every 2 hours and 11 minutes one person under the age of 25 completes suicide. One preventable death is one too many.

4. A Personal Perspective The other side of facts and figures

5. Stephanie’s Story

6. SUICIDAL BEHAVIOR Attempt to solve a problem of intense pain with impaired skills

7. CHARACTERISTICS OF SUICIDE 1. Alternative 2. Crisis Thinking 3. Ambivalence 4. Irrational 5. Communication 7 – (Shneideman, 1985)

8. Youth Suicide is a Preventable Mental Health Problem – Research shows that clues or warning signs can be detected by others. – Research has demonstrated that restriction of lethal means can reduce attempts. – Clinical evidence identifies suicidal thinking as crisis thinking that can be altered by crisis intervention techniques. – Evidence demonstrates the effectiveness of medication & cognitive behavioral treatment for symptoms of depression.

9. Awareness Education about Identification Support and Response Suicide Prevention Strategies

10. What is a “Competent” Prevention Community? Concern for youth suicide prevention is shared by all community members. All members can recognize signs of risk. The community has a coordinated fabric of prevention activities that are integrated into established community services. All members know how and where to get help when a community member is in need, and are willing and able to do so.

11. THE SCHOOL Essential Partner in Prevention: A Limited but Critical Role

12. What educators need to be able to do  Understand basic information about suicide  Know their role in their school’s suicide prevention strategy  Recognize students who may be at risk  Understand crucial, but limited, role of identification and referral

13. Red: Warning Signs Yellow: Risk Factors Green: Protective Factors

14. Risk Factors: Non-Clinical Age Sex Race Sexual orientation “Giftedness” Family – History of suicide – Abuse Exposure – To death of peer Recent Stressors – Loss – Trouble- E.g. being bullied or bullying others – Change – transition – Access to means 14

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17. How can Bullying Affect Students Who are Targeted? Short-term – Sadness, fear, anger, pain, loneliness, and embarrassment – School avoidance; academic problems Long-term – Internal expressions like depression and eating disorders – External expressions may include poor grades, aggression and violence – Very rarely but tragically, suicide attempts and completions; homicide. 17

18. Is Bullying a Suicide Risk Factor? What research tells us about connections between bullying and suicidal ideation – Targeted students are 2-9x more likely to report suicidal thoughts than non-bullied peers. – Students who bully are also at increased risk for suicidal behavior. – Students who both bully and are bullied are at the highest risk. 18

19. Vulnerabilities for Bullying Most common targets: – Sexual orientation – Race – Body Size – Gender presentation Other targets: depressed, learning disabled, socially awkward, developmentally delayed, obese BOTTOM LINE? These are also risk factors for suicide. 19

20. Association between LGBTQ and Bullying and Suicide Rate of suicidal ideation and attempts are higher for sexual minority youth – LGB youth about 3x more likely to make attempt or ideate than non-LGB youth (Silenzio et al, 2007) 50% of sexual minority youth get bullied, threatened, assaulted by peers ( D’Augelli, 1998; Freedman, 2011)

21. Victimization-Suicidality Pathway Pre-existing Vulnerabilities Victimization Depression Suicide ideation, attempts, completions 21

22. Clinical Risk Factors Psychiatric diagnosis Drug / alcohol use Previous attempt 22

23. Most Common Diagnoses in Teen Suicide 23 MALEFEMALE (N=213)(N=46) Depression 50% 69% Conduct Disorder43% 24% Anxiety 19%48% Substance Abuse38%17% 18- to 19-year olds* 60–67%13% Brent et al. 1999, Shaffer et al. 1996

24. Access to Means… Most Preventable Risk Factor 24

25. When Risk Factors Converge 25 Demographic Family Stressors Clinical Exposure Access to Means

26. F = Feelings A = Actions C =Changes T = Threats S = Situations Warning Signs

27. Feelings Hopelessness Anger Worthlessness Emptiness Excessive worry 27

28. Actions Trying to get access to guns or pills Risky or dangerous behaviors Increasing drug/alcohol use Getting into fights Writing suicidal messages on social networking sites 28

29. Changes One of the most significant warning signs in adolescents Changes in moods, actions or behaviors Recent prescription, change in psychiatric medication 29

30. Threats Specific verbal statements :I want to die, I want to kill myself Worrisome innuendos Themes of death /destruction in school assignments 30

31. Situations Situations that may serve as a trigger- when a student’s coping skills are really challenged, especially: – Loss – e.g. family death or divorce; breakup – Change – Getting into trouble 31

32. Personal, behavioral, or situational characteristics that help students become resilient despite risks. Protective Factors

33. Caring relationship with at least one trusted adult Sense of connection/meaningful participation in school Positive self-esteem and good coping skills Access to care for emotional/physical problems, substance abuse Cultural/religious beliefs that discourage suicide and promote self- preservation Protective Factors

34. Fostering Protective Factors Teach students it is okay to ask for help. Give students permission to talk about traumatic events like suicide. Help students identify trusted adults. Encourage participation in school & community activities Acknowledge student efforts Be a good listener, as often as you can

35. Making it Real… DEALING WITH AT-RISK STUDENTS BRAD James Elena Conner

36. Helping At-Risk Students Pay attention to who your students are, not just how they perform academically – Notice their appearance – Observe their social skills / relationships – Monitor their behavior changes

38. Making it Real … DEALING WITH AT-RISK STUDENTS Brad James ELENA Conner

40. What About Elementary School Students? Suicide by children is very rare. About four children in 500,000 kill themselves every year. The suicide rate for 10-14 year olds is on the rise.

41. What About Suicide Prevention for Elementary Students? 1. Don’t teach “Don’t tattle.’ 2. Do teach, “Ask for help if you or someone else is getting hurt” and “Friends help friends.” 3. Focus on promoting helpful behavior and preventing bullying and hurtful behavior. 4. Encourage children to identify least one trusted school adult. 5 Teach social emotional skills – e.g. self-calming and problem-solving skills.

42. Educators’ Role in Review Learning signs of risk in students Identifying at-risk students Referring to appropriate resources 42

43. What About Parents? Parents need to be able to: Understand school’s policies and procedures Recognize signs of trouble in their children Know what to do and where to go for resources Understand how to respond to other at-risk youth

45. Do Students Have a Role in Suicide Prevention ? Awareness of warning signs Strategies for getting help personally Knowledge of ways to help peers Awareness of school and community resources Identification of caring adults

46. Frequently Asked Questions nswering Common Questions 46 Is there any crossover between bullying prevention programs and suicide prevention programs?

47. Are School Programs That Address Suicide Safe? Frequently Asked Questions

48. Is Talking about Suicide Just a Way for Someone to Get Attention?

49. Frequently Asked Questions Can Talking about Suicide Plant the Idea in the Minds of Vulnerable Teens?

50. Stacy’s Story

51. FREE Resources for the Competent Community Teacher training online Parent video- “Not My Kid” Available free at: www.sptsusa.org

52. www.sprc.org Suicide Prevention Resource Center National resource www.afsp.org American Foundation for Suicide Prevention Printed materials & resources www.suicidology.org American Association of Suicidology Data, resources, links www.maine.gov/suicide Maine Youth Suicide Prevention Program Extensive resources and information on youth suicide Additional Resources

53. It’s in the Shelter of Each Other…