Psychologist Veronika Lakis-Mičienė Didactic Methods for Teaching Children with Mood Disorders: Noticing Risks and Preventing Suicide Crises at School Psychologist Veronika Lakis-Mičienė Veronika.lakis@gmail.com www.erdvesau.lt

What are mood disorder? (ICD-10) A category of mental health problems fundamental disturbance is a change in affect/mood: to depression; to elation;

Symptoms in classroom: Persistent feelings of sadness Feeling hopeless or helpless Having low self-esteem Feeling inadequate Excessive guilt Feelings of wanting to die Loss of interest in usual activities or activities once enjoyed Difficulty with relationships Sleep disturbances (for example, insomnia, or hypersomnia) Changes in appetite or weight Decreased energy Difficulty concentrating A decrease in the ability to make decisions Suicidal thoughts or attempts Frequent physical complaints (for example, headache, stomach-ache, or fatigue) Running away or threats of running away from home Hypersensitivity to failure or rejection Irritability, hostility, aggression

Symptoms in classroom: Difficulty achieving in school Constant anger Rebellious behaviours Trouble with family Difficulty with friends and peers

Why do we need to talk about suicide? Suicide is the second leading cause of death among 15–29- year-olds in the world; children with mood disorders are at higher risk of becoming suicidal.

Age-standardized suicide rates (per 100 000 population), both sexes, 2012, WHO

How big is the problem?

One class of schoolchildren 930, from them: One class of schoolchildren

Personal attitudes towards suicide: what helps and interferes to notice signs? „ASSIST“ training

Myths about suicide

Once we become aware of our attitudes – they are less likely to interfere.

Why do people commit suicide? Biological Psychological Environmental factors

Warning signs: how to notice that student is suicidal? What do they say? How do they feel? How do they act?

Behavior we see: Threatening to hurt or kill themselves Planning ways to kill themselves and/ or trying to access the means to kill themselves Talking or writing about death, dying or suicide Expressing feelings of hopelessness or worthlessness, that life is not worth living Engaging in reckless or risky behaviour without concern for their safety Talking or writing about being a burden to others Increasing their use of drugs or alcohol Withdrawing from friends, teachers and family Noticeable changes in mood including increased levels of anger or agitation Taking less care in their appearance (not washing, appearing dishevelled, etc.) Giving away possessions Saying goodbye to loved ones.

How to talk about suicide? Seriously Ask them directly Show you care Calmly

If immediate or high risk: stay with them contact their parent or guardian remove access to methods of suicide or harm contact mental health service

Do not: take on the role of being a counsellor; do anything that makes you feel uncomfortable; guarantee confidentiality to a student.

Returning to school following self-harm or attempted suicide Collaborative approach to supporting the young person at school Identify a key contact at school Information sharing with school staff Safety plan Graduated return to school Discussing the suicide attempt or selfharm with other students?

Safety plan

React as a community: school policy on Prevention Intervention Postvention

How do we talk? Romeo and Julieta?

How do we talk? On 28 March 1941, Woolf drowned herself 

How do we talk? On 27 July 1890, aged 37, Van Gogh shot himself 

How do we talk?

Helpful attitudes towards suicide in your classroom Non-judgmental Unromanticised Help seeking “There is always way out”

How to helps myself?

How to helps myself? Seek out your support team Debrief with external professionals Monitor your own reactions and take care of your personal needs Plan ahead where possible and have a contingency plan to manage difficult situations in the classroom/school Maintain structure and routine in the classroom

How to helps myself? Time management Take some time out and arrange for someone to relieve you if you feel unable to carry out your role Use positive coping strategies to manage distress Avoid unhealthy coping strategies Maintain a healthy work/life balance If difficulties persist beyond a few weeks after the suicide, staff are encouraged to seek additional support or professional help.