Suicide Prevention, Intervention & Postvention in Schools Information and Support for Teachers YCDSB

Suicide is a Difficult Topic… Most of us have been touched, professionally and/or personally, by suicide Important to support one another as we approach this topic today YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus 2

SESSION OUTLINE Overview of Suicide in Children and Youth Risk Factors/Vulnerabilities Bullying and Suicide Triggers Contagion Effect The Role of Social Media Protective Factors Warning Signals School Response to Suicide: Helpful Prevention, Intervention and Postvention Strategies Self-Care Question/Answer SESSION OUTLINE

Child and youth suicide BRIEF OVERVIEW Child and youth suicide

WHAT DO WE BELIEVE in the case of suicide? Traditional Catholic Teaching recognizes that it is both inappropriate and impossible for observers to judge the moral quality of another person’s action. It is also our teaching as noted in the Catechism of the Catholic Church, article 2282 that, “Grave psychological disturbances, anguish, or grave fear of hardship, suffering, or torture can diminish the responsibility of the one committing suicide.” Any factor which diminishes the freedom of a person diminishes the sinfulness of a deed: persons who die by suicide are recognized to have been under such overwhelming pressure that their freedom (and therefore the sinfulness of the act) are significantly diminished. YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

WHAT DO WE BELIEVE in the case of suicide? (Cont`d) We need to always remember God’s unconditional love for us all; if the parents of someone who has died by suicide continue to love the person, we can be sure that God too remains loving and compassionate towards a person whose suffering has resulted in such calamitous action. What gives us consolation is knowing that the individual who has died by suicide is now with God. (Adapted in part from YCDSB Board Resource: School Crisis Response Guidelines: Depression and Suicide; Prevention and Intervention, April, 2004) YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Non-Suicidal Self-Injury SUICIDAL BEHAVIOUR Non-Suicidal Self-Injury A deliberate attempt to cause injury to one’s body without the conscious intent to die Suicidal Ideation Suicidal thoughts that include both contemplating death by suicide and planning actions that could result in death Suicide Attempt Self-harming behaviour that includes an intention to die Death by Suicide Self-harming behaviour that results in death YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

FACTS AND FIGURES 2nd leading cause of death after accidents, accounting for 17.3- 20.4% of adolescent mortality (but important to put this in context, death is relatively uncommon in this age group) 1.4% of all suicides occur in children under 14 years of age Death by suicide is more prevalent in males than females aged 15-19 Recent Canadian epidemiological study shows overall stable rates of suicide over the past 30 years, but trends are changing: decreasing rates for males and increasing rates for females (Skinner & McFaull, 2012) YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Role of teachers Awareness of need for Intervention Identification and Referral Supporting Vulnerable Students Supporting is defined as providing accommodations, talking nicely, being encouraging, etc. It is not the teacher's responsibity to determine whether it is true or not. Information is to be taken at face value and it is not their responsibility to investigate the self-harm issues. Role is not to determine if student has potential to attempt suicide or not YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Importance of teachers Students talk to teachers You make a difference You know Develop- ment Unique position Teachers Year after year, teachers see cohort after cohort of students and come to know normal developmental characteristics of adolescent students. They can identify changes that may reflect concerns. Students do approach teachers. Issues can manifest themselves through student’s work (essays, journals, artwork, music, poetry), social media (facebook, Tumbler, twitter). YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

The complexity of risk RISK Risk Factors Triggers Protective Factors Define terms YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Risk Factors – self Mental illness (e.g., depression, mood, anxiety, conduct disorders) Past suicidal behavior Substance use Unstable mood, high impulsivity Rigid thinking or coping patterns Poor physical health / chronic illness Additional risk factors based on our own clinical experience are pregnant teens and their partners. NOTE: These risk factors are correlational and not causal; typically it is a compounding of risk factors that is associated with suicidal behavior. YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus 12

Risk Factors – home Family history of suicides / attempts Parental mental illness Alcohol / substance abuse in the home History of violence and/or abuse Divorce, separation, other losses, death Tension and aggression between parents Parental lack of time; rejection; neglect NOTE: These risk factors are correlational and not causal; typically it is a compounding of risk factors that is associated with suicidal behavior. YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus 13

Risk Factors – school/community Learning challenges Disengagement from school Lack of connectedness Marginalization Discontinuity in identity (cultural, language, gender, sexual) Some communities are at heightened vulnerability (e.g., aboriginal, LGBTQ, homeless) Negative social relationships, including bullying YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

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LONELY CONFUSED WORTHLESS YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

LONELY CONFUSED WORTHLESS YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

LONELY CONFUSED WORTHLESS YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

LONELY CONFUSED WORTHLESS LAST STRAW EVENT LONELY CONFUSED WORTHLESS Underscores the complexity of the issue – Emphasizes the important role of the classroom teacher as well as communication with the home. Helps to understand the context of the student’s behaviour. YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Increases risk for bullying Bullying and suicide Increases risk for bullying Pre-existing vulnerability Victimization Which are the risk factors for: New or Exacerbated: Anxiety Depressed mood Diminished self-worth Feelings of entrapment Loneliness Withdrawal Sleep/earing problems Hopelessness Suicide ideation Suicide attempt Death by suicide Adapted Lenny Berman 2010 Bullying and Suicide 8doc.webinar American Association of Suicidology YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

triggers Break up with boy/girlfriend Conflicts and increased arguments with parents and/or siblings Loss of close friend (moves, betrayal) School related difficulties-conflicts with teachers, classmates School failures Difficulties with the law Change in parents’ financial status Serious illness or injury in family member Real or perceived loss of status YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Possible Motivations for Suicide An escape from intolerable pain The wish to join a lost love one Retaliation for (perceived) abandonment To obtain love and attention (“manipulation”) Atonement for one’s sins Rage turned inward Psychotic experience A desperate attempt to take control A last cry for help YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus 22

contagion Mimicking of suicidal behaviours Occurs when suicidal behavior influences an increase in the suicidal behavior of others Multiple suicidal behaviors/suicide deaths that occur within a geographical area or fall within an accelerated time frame may represent a potential cluster Although clusters are rare, they are most common amongst adolescents Contagion – begin mimicking Important not to glamorize YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus 23

The role of cyber/social media Increasingly there are sites, chat rooms and blogs that promote suicidal ideation Methods of suicide are discussed on-line and some researchers have suggested that increases in particular methods in recent years may be related to this dialogue The rapid spread of rumours and details of deaths by suicide is difficult to manage Paradoxically, social media (Facebook, Twitter, etc.) may hold potential benefits for suicide prevention (Skinner & McFaull, 2012) YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

PROTECTIVE FACTORS Problem solving, life & communication skills Sociability Resilient personality A sense of belonging (school, community) Secure attachment to positive parent/family Personal moral or religious convictions prohibiting self- harm and supporting the value of life Access to other caring & supportive adults Prosocial peers Appropriate discipline, limit setting & structure Opportunities to develop self-esteem Good mental health Access to professional services (counselling) Access to other caring & supportive adults– highlight the school-based supports (BRS, guidance, psychologist, chaplaincy, teacher) as well as community supports (e.g., therapist, coach)  someone they trust and have a positive relationship with YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

The explanations and the solutions are equally complex. Youth suicide is complex and is often the result of many converging factors. The explanations and the solutions are equally complex. YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Suicide prevention, intervention, & postvention Strategies for Suicide prevention, intervention, & postvention

School response to suicide Prevention Intervention Postvention

What is suicide prevention? Efforts to reduce the risk of suicidal thoughts and behavior amongst students in a systematic way

What is intervention? Practices involved in recognizing and responding to students with suicidal ideation or behavior Practices involved in supporting vulnerable students transitioning to and from mental health care YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

What is postvention? Support for school communities in responding to suspected, attempted, or death by suicide YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Helpful prevention strategies Safe and accepting school culture Social emotional learning (coping skills, conflict resolution, e.g., Family Life Program, Tribes, Second Steps, Restorative Practices) Early identification and treatment of mental health problems Information dissemination (staff, parents, students) Many of these activities are already underway in your daily teaching and school community building Increasing awareness by sharing information and strategies, like this presentation today YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Warning signals: behavioural Loss of interest in former activities Withdrawal from social contact Difficulty concentrating, problems with judgment and memory Dramatic shift in quality of academic performance Feelings of sadness, emptiness and hopelessness, often expressed in written assignments and art Sleep disturbances These signals also relate to problems in mental health more generally YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Warning signals: behavioural Strong and overt expressions of anger and rage Excessive use of drugs and/or alcohol Promiscuous behaviour Uncharacteristic delinquent, thrill-seeking behaviour Self-mutilation (e.g., cutting, burning hair pulling, skin picking) Occurrence of previous suicidal gestures or attempts Planning for death; making final arrangements; giving away favourite possessions YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Warning signals: COMMUNICATION Statements revealing a desire to die, or a preoccupation with death Nihilistic comments: life is meaningless, filled with misery, what’s the use of it all? Verbal or written threats Sudden cheerfulness after prolonged depression may be relief because decision has been taken

HELPFUL INTERVENTIONS Know board procedure Know your role Clarify what supporting students means for teachers – both immediate and ongoing strategies that may assist a student Role is not to be a counsellor or counsellor YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus 36 36

Current Self-Harm Procedures Teacher Role Admin Role “What do I do?” Someone has a concern or student reports self-harm Awareness Literacy “I need to…” Always take it seriously and Report immediately to Admin (Principal/VP) and/or designate Communication between family, school, community agencies essential “What do we do?” Admin consults with Guidance/SSC/Psych Parent contact & medical evaluation Ongoing communication, monitoring & follow-up Expertise

HELPFUL INTERVENTION- TEACHER ROLE DO: Identification & Referral Be aware of warning signals Take the warning signs/threats seriously – do not ignore Facilitate Assessment and Care Notify Administration (and guidance) immediately YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

HELPFUL INTERVENTION- TEACHER ROLE DO: Support Vulnerable Students Provide immediate and calm support to the student Ensure safety and supervision Practice active listening Provide classroom accommodations to reduce stress YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

HELPFUL INTERVENTION TEACHER ROLE– DO’S Know your limits/Comfort level Consult/Debrief Work as a Team Document Actions YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

WHAT YOU CAN SAY I’m glad you came to talk to me. I know this is hard for you. It sounds like you’re really overwhelmed but I’m so glad you shared. I’m so proud of you because I know it took a lot of courage to come forward to share this information. I’m concerned for your safety…part of ensuring your safety means I need to share this information with the Administration and Guidance. You are not in trouble – they will know how to get you the help you need.

WHAT NOT TO DO DON’T: Ignore the signals Wait Panic Do not promise confidentiality – Safety first Debate the morality of suicide Minimize their feelings (e.g., by telling the person to be grateful, or telling them they have too many good things going for them to feel this way) Do not reassure them that everything will be fine Challenge the person to go ahead Assume the person isn’t the suicidal type. Anyone can be suicidal Do not leave them alone/ unsupervised Do not work alone YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

POSTVENTION STRATEGIES Following Suicide Attempt Create a school safety plan with the student and support staff (BRS/student support counsellor, psychologist and/or guidance) Follow-up with student, student’s support group, and reporting teacher Regular in-school monitoring by support staff (guidance, student support counselor) Observe student: mood, behavior, attendance, academic performance Share observations with relevant staff (guidance, admin, etc) Provide academic accommodations as needed (e.g, extra time, reduce quantity). Provide atmosphere of caring, acceptance and support (e.g., encourage, recognize strengths) Following suicide attempt strategies and following completed suicide strategies and protocols are different School admin will walk staff through procedure in that situation YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

TAKING CARE OF YOURSELF Suicide is a special kind of school crisis that impacts us in significant ways, professionally and personally The School Team needs to work together, to debrief often, and to reach out when members are struggling Members need to practice self-care deliberately Deliberately means…recognize and think about your own needs, knowing your signs for stress, strategies that have worked in the past, what works for you You are not alone – consult, debrief frequently

SOURCES, with thanks MH Leader Suicide Subgroup Ian Manion, Ian Brown, Ontario Centre of Excellence for Child and Youth Mental Health Ian Brown, School Mental Health ASSIST Stephan Roggenbaum & Katherine Lazear, University of South Florida Key Resources: SAMHSA Toolkit, Suicide Postvention Guidelines South Australia, Principal Leadership 2009, NASP Postvention Strategies for School Personnel, Kutcher 2008 YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

CONTACT SCHOOL MENTAL HEALTH ASSIST LEAD Dr. Schrine Persad Chief Psychologist, York Catholic District School Board schrine.persad@ycdsb.ca 905-713-1211, ext. 11656 YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus

Q&A YORK CATHOLIC DISTRICT SCHOOL BOARD :: Collaborative Learning Inspired By Jesus