Some Secrets SHOULD be Shared…Some Secrets SHOULD be Shared…SOS Signs of Suicide®

Prevention Programs for Middle & High Schools

Screening for Mental Health, Inc.

Screening for Mental Health, Inc.

Screening for Mental Health, Inc. (SMH) is a non-profit 501(c) (3) organization that develops evidence-based mental health education and screening programs for use by members of the public.

The mission of Screening for Mental Health is to promote the improvement of mental health by providing the public with education, screening, and treatment resources.

Programs include: SOS Signs of Suicide® Prevention ProgramsSigns of Self Injury Prevention Program

CollegeResponse® National Depression Screening Day®

National Alcohol Screening Day® National Eating Disorders Screening Program®

WorkplaceResponse® HealthcareResponse® Military PathwaysTM

FACTS regarding suicide Prevalence of Suicide Among Young People

Nationally, suicide is the 3rd leading cause of death among children ages 15-24 (4,405 deaths in 2006) (CDC, 2004). In Kentucky it is the 2nd leading cause of death for ages 15-24 (2nd to accidents) and 4th for 10-14.

Whereas suicides accounted for 1.4% of all deaths in the U.S. annually, they comprised 12% of all deaths among 15-24-year-olds. Each year, there are approximately 10 youth suicides for every

100,000 youth.Each day, there are approximately 11.5 youth suicides.Every 2 hours and 5 minutes, a person under the age of 25

completes suicide.

Adolescent suicidal behavior is deemed to be underreported because many deaths of this type are classified as unintentional or accidental (World Medical Association, 2004).

Depression & YouthIn children and adolescents, an untreated depressive

episode may last between 7 to 9 months, potentially an entire academic year!

Overall, 20% of youth will have one or more episodes of major depression by the time they become adults (NAMI, 2003).

Major Depressive Disorder is the leading cause of disability in the U.S. for people aged 15-44 (WHO, 2003).

More than 90% of people who complete suicide have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder (NIMH, 2009).

Depression & YouthIn 2007, 8.2% of adolescents (an estimated 2 million

youth aged 12 to 17) experienced at least one major depressive episode in the past year (SAMHSA, 2009).

What is a Major Depressive Episode?DSM-IV: a period of 2 weeks or longer in which there is

either a depressed mood or a loss of interest or pleasure AND at least 4 of the following:

Increase or decrease in appetite Problems with sleeping Fatigue or energy loss Feelings of worthlessness or excess guilt Diminished ability to think or concentrate

National Longitudinal Survey of Youth, 1997

Based on data that followed a sample of adolescents into young adulthood, from 1997 (15-17 years old) to 2005 (23-25 years old)

8% of the youth were designated as experiencing depression/anxiety These youth engaged in more risky behavior during

adolescenceOver a third (35%) did not earn a high school diplomaThese youth were less likely to obtain a degree from a 4-year

college (13% vs. 27% of the no depression/anxiety sample)Less than half (43%) consistently connect to school and/or labor

market between the ages of 18 to 24 (compared to 61% of no depression/anxiety sample)

Source: Urban Institute estimates of the National Longitudinal Survey of Youth 1997

By the Numbers…2009 Youth Risk Behavior Survey of

Kentucky High School students found that:26.7% felt so sad or hopeless for 2+ weeks that

they stopped doing some usual activity.15.1% seriously considered attempting suicide.12.5% made a suicide plan.8.8% attempted suicide.

If you look around a class of 25 students, at least 4 high school

students are likely to have seriously considered suicide, and 1 to 2 are

likely to have tried to kill themselves in the past year.

By the Numbers…2009 Youth Risk Behavior Survey of

Kentucky Middle School students found that throughout their life time:17.4% seriously considered attempting suicide.11% made a suicide plan.6.5% attempted suicide.

In a class of 25 students, at least 4 middle school students are likely to have seriously considered suicide, and 1 or 2 are likely to have tried to kill themselves at some point in their lives.

What are some myths and facts about suicide?

MYTH: People who talk about suicide don't complete suicide.FACT: Many people who die by suicide have given definite

warnings to family and friends of their intentions. Always take any comment about suicide seriously.

 

MYTH: Suicide happens without warning.FACT: Most suicidal people give clues and signs regarding their

suicidal intentions.  

MYTH: Suicidal people are fully intent on dying.FACT: Most suicidal people are undecided about living or dying,

which is called “suicidal ambivalence.” A part of them wants to live; however, death seems like the only way out of their pain and suffering. They may allow themselves to "gamble with death," leaving it up to others to save them.

MYTH: Males are more likely to be suicidal. FACT: Males are four times more likely to kill themselves than

females. Females attempt suicide three times more often than males do.

 

MYTH: Asking a depressed person about suicide will push him/her to complete suicide.

FACT: Studies have shown that patients with depression have these ideas and talking about them does not increase the risk of them taking their own life.

 

MYTH: Improvement following a suicide attempt or crisis means that the risk is over.

FACT: Many suicides occur within days or weeks of "improvement," when the individual has the energy and motivation to actually follow through with his/her suicidal thoughts. The highest suicide rates are immediately after a hospitalization for a suicide attempt.

What are some myths and facts about suicide?MYTH: Once a person attempts suicide, the pain and shame

they experience afterward will keep them from trying again.FACT: The most common psychiatric illness that ends in

suicide is Major Depression, a recurring illness. Every time a patient gets depressed, the risk of suicide returns.

 MYTH: Sometimes a bad event can push a person to

complete suicide.FACT: Suicide results from having a serious psychiatric

disorder. A single event may just be “the last straw.”

Why do people want to end their lives?

Situations that might contribute to a feeling of hopelessness include:

Break-upsFamily problemsSexual, physical or mental abuseDrug or alcohol addictionMental illness, including schizophrenia, bipolar disorder and

depressionThe death of a loved oneSchool or work problemsUnemployment or being unemployed for a long timeFeeling like you don't belong anywhereAny problem that seems hopeless.

Suicide – Risk FactorsRisk factors are not necessarily causes.Suicidal distress can be caused by psychological,

environmental, and social factors.The first step in preventing suicide is to identify

and understand the risk factors.The strongest risk factors for suicide in youth are

depression, substance abuse, and previous attempts (NAMI, 2003).

Mental illness is the leading risk factor for suicide.Over 90% of children and adolescents who die by

suicide have a least one major psychiatric disorder (Gould et al., 2003).

SUICIDE: A MULTI-FACTORIAL EVENT

Neurobiology

Severe MedicalIllness

Impulsiveness

Access To Weapons

Hopelessness

Life Stressors

Family History

SuicidalBehavior

Personality Disorder/Traits

Psychiatric IllnessCo-morbidity

Psychodynamics/Psychological Vulnerability

Substance Use/Abuse

Suicide

What do all school staff need to know?

Know how to ask the “tough question”. Asking questions like “are you having thoughts about suicide or killing yourself ?” or “do you ever wish you could go to sleep and not wake up?” doesn’t cause suicidal thoughts and can reduce anxiety in at-risk student and increase help-seeking.

Do not promise to keep a secret. Let the student know that you care too much for his/her well-being to keep a secret. Remind them that it is a sign of strength to seek help.

What do all school staff need to know?

Every staff member should know what they are expected to do when they know or suspect that a student is at-risk of suicidal thoughts or actions OR if a student dies by suicide.

Be persistent and prepared to act.

Don’t be judgmental or placating, but do offer hope.

Never leave the student alone.

AcknowledgeAcknowledge that you are seeing the signs of

depression or suicide in a friend and that it is serious

CareLet your friend know you care about them and that

you are concerned that he or she needs help you cannot provide

Tell Tell a trusted adult that you are worried about

your friend

Major Points of Postvention Plans (if a student dies by suicide)

Plan in advance of any crisis; select and train a crisis team.Verify report of suicide from medical examiner or police.Assess situation; adjust size of crisis team accordingly.Disseminate information to faculty, student and parents.

Be sensitive to parents wishes and always be truthful.Check records and provide individual counseling for all

identified students at-risk.Arrange for other student/faculty counseling opportunities.Coordinate or consult on memorial plans by the school.Make a home visit to the family of the deceased.Respond to media/community inquiries as appropriate.Follow-up with continued counseling or refer for outside

treatment as necessary.

Major Points of Suicidal Crisis Plans

Plan in advance of any crisis (risk management). Select and train a crisis team. Establish protocol (communication, direction and

coordination, health and safety) for dealing with: Students at-risk of suicidal behavior. Students who threaten or attempt suicide. How parents/guardians will be notified. When and how school personnel will be notified. Students returning to school after threat or attempt. Assisting other students/personnel affected in

days/weeks after event. Establish agreements with local mental health, crisis

service providers and other resources. Ensure that all school personnel are trained and

understand their role in dealing with student suicidal threats or behavior.

Parents/Guardians as Partners in Prevention

• Studies have shown that as many as 86% of parents were unaware of their child’s suicidal behavior.

• The percentage of parents who are involved in the student’s activities is very small.

-Doan, et al, 2003• By raising parental awareness, schools can partner

with parents to watch for signs of these problems in their children and instill confidence for parents seeking help for their child, if needed.

• Involving parents may increase cooperation in prevention efforts and broaden community support.

What do prevention programs aim to do?

Enhance awareness and increase information among students, staff, family, and community

Change environments and systems – with particular concern for diversity

Enhance identification of those at risk and build capacity of school, family, & community to help

Enhance competence/assets related to social and emotional problem solving (e.g. stress management, coping skills, compensatory strategies)

Enhance protective buffers (Resiliency Factors)

Why should schools play a role?

Schools cannot achieve their mission of educating the young when students’ problems are major barriers to learning and development.

Schools are at times a source of the problem and need to take steps to minimize factors that lead to student alienation and despair.

Schools also are in a unique position to promote healthy development and protective buffers, offer risk prevention programs, and help to identify and guide students in need of special assistance.

Center for Mental Health in Schools at UCLA (http://smhp.psych.ucla.edu)

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As the Carnegie Task Force on Education has stated:

“School systems are not responsible for meeting every need of their students. But when the need directly affects learning, the school must meet the challenge.”

SOS Signs of Suicide® Program Goals

Decrease suicide and attempts by increasing knowledge and adaptive attitudes about depression.

Encourage individual help-seeking and help-seeking on behalf of a friend.

Link suicide to mental illness that, like physical illness, requires treatment.

Engage parents and school staff as partners in prevention by educating them to identify signs of depression and suicide and by providing information about referral resources.

Reduce stigma associated with mental health problems.Encourage schools to develop community-based partnerships.

SOS Signs of Suicide® Student Goals

Help youth understand that depression is a treatable illness.Educate youth that suicide is not a normal response to stress,

but rather a preventable tragedy that often occurs as a result of untreated depression.

Inform youth of the risk associated with alcohol use to cope with feelings.

Increase help-seeking by providing students with specific action steps to take if they are concerned about themselves or others and by identifying resources.

Encourage students and their parents to engage in discussion about these issues.

Encourage peer-to-peer communication about the ACT® help-seeking message.

On the Day of the Program• Introduce program• Show video• Facilitate discussion• Students complete and score screening

forms and Response Card • Set expectation about when follow-up can

be expected; provide referral information• Follow up with students requesting help• Respond to requests for help; track

students seeking help using the Student Follow-Up form

Student Screening Forms

Make sure to review with students…SIGNS (SYMPTOMS) OF DEPRESSIONDepressed mood (can be sad, down, grouchy, or irritable)Change in sleeping patterns (too much, too little, or disturbed)Change in weight or appetite (decreased or increased)Speaking and/or moving with unusual speed or slownessLoss of interest or pleasure in usual activitiesWithdrawal from family and friendsFeelings of worthlessness, self-reproach, or guiltFeelings of hopelessness or desperationDiminished ability to think or concentrate, slowed thinking or

indecisivenessThoughts of death, suicide, or wishes to be dead 

OTHER INDICATIONS OF DEPRESSIONExtreme anxiety, agitation, or enraged behaviorExcessive drug and/or alcohol use or abuseNeglect of physical health

BASED ON THE VIDEO AND/OR SCREENING, I FEEL THAT:

□ I need to talk to someone … □ I do not need to talk to someone … ABOUT MYSELF OR A

FRIEND. NAME(PRINT):_________________________________ HOMEROOM SECTION:_________________________

TEACHER:_____________________________________ IF YOU WISH TO SPEAK WITH SOMEONE, YOU

WILL BE CONTACTED WITHIN 24 HOURS. IF YOU WISH TO SPEAK WITH SOMEONE SOONER, PLEASE APPROACH STAFF IMMEDIATELY.

Reducing Liability – Common Themes in Lawsuits

• The institution ignored warning signs of suicide.

• The institution provided the tools that the student used for suicide.

• The institution took insufficient steps to address the warning signs.

• The institution failed to notify the family about the student’s condition.

-United Educators, “The Suicidal Student: Issues in Prevention, Treatment, and Institutional Liability” Roundtable Discussion, 2003

Prompt disclosure of a suicide threat to a parent is both legal and prudent.

Steps taken by the school should be documented, including parental follow-up and clinical care status.

Joint decision making and good documentation help justify decisions if they should later be challenged.

Confidential materials should be stored under lock and key.

Always consult with the school legal department for questions regarding policies.

Reducing Liability It is important to convey to students and

parents that the screenings being conducted in your school are informational, not diagnostic. Diagnoses, treatment recommendations, and second opinions should not be given.

Faculty, staff, parents, and students should be informed that the program is primarily for educational purposes and is not a substitute for a diagnostic examination. Program team members will recommend that students seek complete evaluations if their symptoms are consistent with depression and/or suicidality.

Student Mental Health Screening:

A Risk Management Perspective

United Educators actively encourages schools to provide a safe environment for students and reduce the institution’s liability. They believe that the SOS Suicide Prevention Program can serve as an important risk management tool for schools.

A record of prevention programs is important. Many causes of serious student injury and death relate to mental health concerns.

Screening efforts and counseling services help show that the school takes student mental health issues seriously.

Constance Neary, Vice President for Risk Management, United Educators Insurance

The National Suicide Prevention Lifeline is a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress.

Your call will be routed to the nearest crisis center to you.

* Know your school protocol for handling students at-risk.

For more information, contact:Candice Porter, MSW, LICSWProgram Coordinator781.239.0071 x122cporter@mentalhealthscreening.orgwww.MentalHealthScreening.org/schoolsORJan UlrichActing Kentucky Suicide Prevention Coordinator502.564.4456jan.ulrich@ky.govwww.kentuckysuicideprevention.org

References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision).

Washington, D.C.: Author.

Aseltine, R., et al. (2007). Evaluating the SOS suicide prevention program: A replication and extension. BMC Public Health 7(161).

Centers for Disease Control and Prevention. (2008). Suicide: Facts at a glance. Atlanta, Georgia: U.S. Department of Health and Human Services Centers for Disease Control and Prevention.

Center for Disease Control and Prevention. (2008). Web based injury statistics query and reporting system (WISQARS). Retrieved June 11, 2009, from http://www.cdc.gov/injury/wisqars/index.html

Doan, J., Roggenbaum, S., & Lazear, K. (2003). Youth suicide prevention school-based guide. Tampa, FL: Department f Child and Family Studies, Division of State and Local Support, Louis de la Parte Florida Mental Health Institute, University of South Florida.

Gould, M., et al. (2003). Youth suicide risk and preventive interventions: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42 (4), 386-405. 

Grossman, D., et al. (2005). Gun storage practices and the risk of youth suicide and unintentional firearm injuries. Journal of the American Medical Association, 293 (6), 707-714.

Guild, M., Marrocco, F., Kleinman, M, Graham, J., Mostkoff, K, Cote,J. & Davies, M. (2005). Evaluation iatrogenic risk of youth suicide screening programs: a randomized controlled trial. Journal of the American Medical Association, 293 (13).

Kalafat, J., Ryerson, D., and Underwood, M. Lifelines ASAP - Lifelines Adolescent Suicide Awareness and Response Program. Piscataway, NJ: Rutgers University.  

 

References   Kerr, M. Suicide Prevention in Schools: Best practices and questionable practices [PDF document]. Retrieved

from STAR-Center Online Website: http://www.starcenter.pitt.edu/suicidepreventionresources/56/default.aspx

Litts, D. (August 2, 2004). USAF Suicide Prevention Program: Lessons for Public Health Prevention in Non-military Communities. Retrieved June 2, 2009 from http://www.sprc.org/traininginstitute/disc_series/disc_1.asp

National Adolescent Health Information Center. (2006). Fact sheet on suicide-Adolescents and young adults. San Francisco, CA: Author, University of California, San Francisco.

National Institute of Mental Health. (2009) Suicide in the U.S., statistics and prevention. Retrieved June 15, 2009, from http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml

National Alliance of Mental Illness (NAMI). (2003). Depression in Children and Adolescents. Retrieved on June 16, 2009 from http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=17623

Office of Applied Studies. (2006). Results from the 2005 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 06-4194, NSDUH Series H-30). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Shenassa, E., Rogers, M., Spalding, K. (2004). Safer storage of firearms at home and risk of suicide: a study of protective factors in a nationally representative sample. Journal of Epidemiology and Community Health, 58, 841-848.

  UCLA Center for Mental Health in Schools. School community partnerships: a guide. Retrieved from

http://smhp.psych.ucla.edu/pdfdocs/guides/schoolcomm.pdf

World Health Organization. (2000). Preventing suicide: A resource for teachers and other school staff. Geneva, Switzerland: Mental and Behavioral Disorders, Department of Mental Health.

What about families and communities?

Engaging families and communities in suicide prevention programs not only tightens the safety net for at-risk students, but sends a clear message that suicide is not just a school issue, it is a community issue.

Invite families and community to a QPR (Question, Persuade, Refer) suicide prevention gatekeeper trainer. Contact Jan Ulrich (jan.ulrich@ky.gov) for more information about this free training.

Host an (SOS) Signs of Suicide preview night. Invite families/community to view the SOS video and ask questions about the program. Find a parent or community member to champion the issue. Having food at the event always helps!

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LMHS and JCPS Resources

Counselors- Jill Crutcher, Carol Sheeley, Cyndi Sullivan (have PREPARE training in addition to school counseling credentials)

School Psychologist - Bethanie Brogli 485-3232Social Worker for region threeStrong community partnership with the Brook, Our

Lady of Peace and Wellstone. Stuecker and Associates works with our

staff/faculty courtesy of the district 9502)452-9227Pam Taylor provides information on the employee

assistance program services 485-343640