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

2. 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
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3. 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

4. Child and youth suicide
BRIEF OVERVIEW
Child and youth suicide

5. 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.
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6. 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)
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7. 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
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8. FACTS AND FIGURES
2nd leading cause of death after accidents, accounting for % 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)
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9. 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
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10. 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).
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11. The complexity of risk RISK Risk Factors Triggers Protective Factors
Define terms
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12. 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.
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13. 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.
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14. 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
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16. LONELY CONFUSED WORTHLESS
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17. LONELY CONFUSED WORTHLESS
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18. LONELY CONFUSED WORTHLESS
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19. 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.
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20. 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
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21. 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
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22. 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
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23. 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
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24. 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)
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25. 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
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26. 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.
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27. Suicide prevention, intervention, & postvention
Strategies for
Suicide prevention, intervention, & postvention

28. School response to suicide
Prevention
Intervention
Postvention

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

30. 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
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31. What is postvention?
Support for school communities in responding to suspected, attempted, or death by suicide
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32. 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
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33. 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
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34. 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
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35. 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

36. 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
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37. 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

38. 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
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39. 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
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40. HELPFUL INTERVENTION TEACHER ROLE– DO’S
Know your limits/Comfort level
Consult/Debrief
Work as a Team
Document Actions
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41. 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.

42. 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
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43. 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
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44. 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

45. 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
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46. CONTACT SCHOOL MENTAL HEALTH ASSIST LEAD
Dr. Schrine Persad
Chief Psychologist, York Catholic District School Board , ext
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47. Q&A
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