Transcript Title of Presentation - Innovative Educators

THE SUICIDAL STUDENT: CRITICAL DO’S
AND DON’TS FOR FACULTY
Brian Van Brunt, Ed.D.
Senior Vice President of
Professional Program Development
The NCHERM Group, LLC
[email protected]
2
• Vignettes from seasoned faculty
that provide thoughtful reflections
and advice from everyday
experience
• Research-based suggestions and
intervention techniques to help
faculty better assess, intervene,
and manage difficult behavior
• Coverage of special populations,
including nontraditional, veteran,
and millennial students
• Discussion of the latest laws and
regulations that should affect and
inform faculty’s decisions
3
Introduction
Warning Signs / What to Do
Case Examples
Training and Outreach
Advice Moving Forward
Introduction
Suicidal Students
• Faculty are often put into the difficult position of
working with students who express suicidal ideations
or plan to die.
• This program will outline some critical approaches to
working with these students both in and out of the
classroom.
4
Introduction
Title II of the Americans with Disabilities Act was revised
(effective March 15, 2011):
• Applies to public colleges & universities
• Likely also extends to private colleges & universities
through OCR’s similar interpretation of Section 504
“Direct threat means a significant risk to the health or
safety of others that cannot be eliminated by a
modification of policies, practices or procedures, or by
the provision of auxiliary aids or services.”
A college or university may take adverse action against a student
who poses a direct threat.
www.ada.gov/regs2010/titleII_2010/titleII_2010_withbold.htm
5
Introduction
To determine if a direct threat exists, a college must make:
• An individualized assessment
• Based on reasonable judgment
That relies on current medical knowledge OR on the best
available objective evidence, to ascertain:
• The nature, duration, and severity of the risk
• The probability that the injury will actually occur
• Whether reasonable modifications of policies,
practices, or procedures or the provision of auxiliary
aids or services will mitigate the risk
www.ada.gov/regs2010/titleII_2010/titleII_2010_withbold.htm
6
Introduction
What does this mean?
As a result of the change in language in Title II of the
Americans with Disabilities Act (ADA), the revised
regulation now deems it unlawful to take adverse action
(e.g. involuntarily separate, suspend or expel) towards a
student solely on the basis of self-harmful or suicidal
behaviors.
This is why most of you are here with us today.
7
Introduction
Additional Resources:
• The National Center for
Higher Education Risk
Management (NCHERM)
and the National
Association of
Behavioral Intervention
Teams (NaBITA) offers a
free white paper to
address this issue.
www.nabita.org/documents/2012NCHERMWHITEPAPERTHEDIRECTTHREATSTANDARDFINAL_000.pdf
8
Introduction
How might you address a student like this?
• Daria has a history of suicide attempts. Last
month, she had an overdose of pills leading to
a 3-day inpatient stay.
• She tells her professor that she “won’t be at
the exam on Thursday. She will likely be dead.”
9
Introduction
How do you feel when students exhibit these
behaviors?
1. Frustrated
2. Scared
3. Annoyed
4. Uncomfortable
5. Not bothered at all
10
Introduction
Suicide Myths and Facts
• Myth No one can stop a suicide; it is inevitable.
• Fact
If people in a crisis get the help they need,
they will probably never be suicidal again.
• Myth Confronting a person about suicide will only
make them angry and increase the risk of
suicide.
• Fact
Asking someone directly about suicide
lowers anxiety, opens up communication,
and lowers the risk of an impulsive act.
http://www.qprinstitute.com/
11
Introduction
Suicide Myths and Facts
• Myth Only experts can prevent suicide.
• Fact
Suicide prevention is everybody’s business,
and anyone can help prevent the tragedy of
suicide.
• Myth Suicidal people keep their plans to
themselves.
• Fact Most suicidal people communicate their
intent sometime during the week
preceding their attempt.
http://www.qprinstitute.com/
12
Introduction
Suicide Myths and Facts
• Myth Those who talk about suicide don’t do it.
• Fact People who talk about suicide may try, or
even complete, an act of self-destruction.
• Myth Once a person decides to complete suicide,
there is nothing anyone can do to stop
them.
• Fact Suicide is the most preventable kind of
death, and almost any positive action may
save a life.
http://www.qprinstitute.com/
13
Warning Signs
Suicide Clues And Warning Signs
The more clues and signs observed, the
greater the risk. Listen to all signs!
14
Warning Signs
Direct Verbal Clues
• “I’ve decided to kill myself.”
• “I wish I were dead.”
• “I’m going to commit suicide.”
• “I’m going to end it all.”
• “If (such and such) doesn’t happen, I’ll kill myself.”
http://www.qprinstitute.com/
15
Warning Signs
Indirect Verbal Clues
• “I’m tired of life. I just can’t go on.”
• “My family would be better off without me.”
• “Who cares if I’m dead anyway.”
• “I just want out.”
• “I won’t be around much longer.”
• “Pretty soon you won’t have to worry about me.”
http://www.qprinstitute.com/
16
Warning Signs
Behavioral Clues
•
•
•
•
•
•
•
•
Any previous suicide attempt
Acquiring a gun or stockpiling pills
Co-occurring depression, moodiness, hopelessness
Putting personal affairs in order
Giving away prized possessions
Sudden interest or disinterest in religion
Substance abuse/relapse after a period of recovery
Unexplained anger, aggression and irritability
http://www.qprinstitute.com/
17
Warning Signs
Situational Clues
•
•
•
•
•
•
•
•
•
Being fired or being expelled from school
A recent unwanted move
Loss of any major relationship
Death of a spouse, child, or best friend, especially by suicide
Diagnosis of a serious or terminal illness
Sudden unexpected loss of freedom/fear of punishment
Anticipated loss of financial security
Loss of a cherished therapist, counselor or teacher
Fear of becoming a burden to others
http://www.qprinstitute.com/
18
Warning Signs
Additional Stressors
•
•
•
•
•
•
•
Relationship problems
Legal problems/substance abuse
Death within family/friends
Bullying
Questions of sexual orientation
Other suicides
Loss of function, hope, dreams
– Academic plans, athletic plans, bodily functions
http://www.qprinstitute.com/
19
Warning Signs
Information Leading to Suicide Attempt
• Two Important Indicators
– History of past suicide
attempts
• Past or multiple past
attempts = HIGHER RISK
– Suicidal Ideation &
Behaviors
• Especially with intent,
(specific plans &
preparatory behaviors)
• Other Important Indicators
– Presence of mental health
disorder
• Mood disorders, anxiety
disorders (e.g., PTSD),
schizophrenia,
AOD/addiction issues,
eating disorders, conduct
disorders
20
Warning Signs
Other Important Indicators
• Psychic pain: hurt, anguish,
misery
• Self-hate: no self-esteem, selfrespect
• Perceived burdensomeness
• Anger, Aggressive tendencies
or history of violent behavior
• Stress: pressured or
overwhelmed
• Agitation: emotional urgency
• Hopelessness: expectation that
things will not get better
• Sleep disturbances
• Intoxication, Recklessness,
Impulsivity
21
Warning Signs
Contextual Issues for College Students
• Social Isolation
– Do they have friends
– What are their relationships (if any) like
– Developmental/Intrapersonal Issues
• Exposure to suicidal behavior
– Either within family or through media
• Suicides on Campus; student’s impulsivity
22
Warning Signs
Contextual Issues that Students Bring to Campus
• Chaotic family history
– Separation or divorce, change
in living situation or residence
– History of violence/impulsivity
within the family
– Access to, or familiarity with,
lethal means
– Mental disorder, drug abuse,
suicide
• Culture of firearms in family
• Victim of Bullying
• History of physical or sexual
abuse
• Discrimination related to being
lesbian, gay, bisexual,
transgender
• Medications
23
Warning Signs
Precipitators to Suicide/Triggering Events
Events leading to shame, humiliation, or despair
• Loss of relationship
• Legal or disciplinary problems
• Interpersonal conflicts
• Failure in class/exams
24
Warning Signs
Those at Highest Risk
–
–
–
–
–
–
History of suicidal ideation & attempts
Current plan
Mental health issues (depression, etc.)
Preparatory acts
Some triggering event
High level of impulsivity
• Common among college students
• Lack of appropriate coping skills
25
Warning Signs
Depression
Hopelessness
Suicidal
Thoughts
26
What to Do
Tips for Asking the Suicide Question:
•
•
•
•
•
•
If in doubt, don’t wait, ask the question
If the person is reluctant, be persistent
Talk to the person alone in a private setting
Allow the person to talk freely
Give yourself plenty of time
Have your resources handy: info card, phone
numbers, counselor
27
What to Do
Remain calm. People often respond to caring,
kindness and efforts to understand their
situation. Try not to think that the student is
personally breaking your rules or trying to
ruin your day.
28
What to Do
Leave the scene to get help if the person
seems threatening to you, or if you feel in
danger. Do not ignore these feelings. While it is
best to never leave a person in crisis alone,
your safety always comes first!
29
What to Do
Call for back-up if there is even an elevated
level of risk. Think of the “hot potato” game.
You don’t want to be left holding the
responsibility. It is your job and responsibility
to report substance abuse, suicidal or violent
behavior.
30
What to Do
Call campus police
immediately when
students hurt
themselves. Rule of
thumb: if you see blood
or a weapon, someone
needs to call the police.
Apply first aid within
your scope of practice
(what you have been
trained to do).
31
What to Do
Follow up on a situation. If you are not face-toface with the student and come by information
second hand, don’t wait to pass it on. Don’t
wait to pass on information or wait until you’re
one-on-one if the situation needs immediate
attention.
32
What to Do
Don’t worry that your
questions or calls are going
to make the student worse.
Often, the suicidal student
can become frustrated by
people trying to help.
Remember, the students are
responsible for their actions. You are
responsible for passing the
information along.
33
Case Examples
What is a “chronically suicidal” student like?
• Kevin shares a history of self injury and has numerous
cuts on his arms, which are visible and upsetting to
other students. He tells them “I’m always depressed
and think of killing myself. I don’t think I’ll do it…but I
never really know…”
34
Case Examples
Prochaska and DiClemente’s
Change Theory
35
Stage of Change
Pre-contemplation
Faculty Member’s Motivational Task
Raise doubt; increase their perception of risk and
problems with current behavior
Contemplation
Help student head towards change out of their current
ambivalence; help them identify risk for not changing;
strengthen self-efficacy for changing current behavior
Preparation for
Action
Help the student identify and select the best initial course
of action; reinforce movement in this direction
Action
Maintenance &
Relapse
Help the student take steps towards change; provide
encouragement and praise
Teach student relapse prevention skills
Case Examples
Can eating disorders be considered suicidal?
• Nancy is taking a full load of courses at your
community college.
• Nancy has a low BMI, engages in
binging/purging cycles and over-exercises
several times a day for 6-8 hours.
• She fainted a second time in a bathroom
outside the classroom.
37
7 Habits of Highly
Effective People
(Stephen Covey)
Be Proactive
(create environment, choose response before problems start)
Begin with the End in Mind
(create cognitive mindset, what is the vision, what is the habit)
Put First Things First
(application of mindset, habit in action, short-term goals)
Stephen Covey: 7 Habits of Highly Effective People
Think Win-Win
(achievements depend on cooperation, working together)
Understand then be Understood
(diagnosis first, then prescribe)
Synergize
(the whole is greater than the sum of its parts)
Sharpen the Saw
(maintain and renew)
Training and Outreach
What can we do?
• Prevention
•
Intervene before there is a problem
• Gatekeeping
•
Develop & maintain relationships
• Education
•
Stop the stigma, support the person
40
Training and Outreach
Educate the campus & demystify:
– Orientation programming
– Creative speakers to talk about mental illness
– Awareness campaigns
Train those who see students:
–
–
–
–
–
Faculty and administrators
Office staff
Coaches and advisors
Police, parking, and custodial
Student leaders and resident assistants/advisors
41
Training and Outreach
Additional Resources:
• The JED Foundation
• Active Minds: www.activeminds.org
• www.facebook.com/BipolarBoy
42
Training and Outreach
QPR
• QPR is one approach to educating staff,
faculty, and students in order to prevent
suicides on campus.
• This approach is similar to CPR in its focus on training those in a
short, 90-minute session provided to non-clinical staff.
– Question signs/symptoms of suicidal behavior
– Persuade people to get help
– Refer them directly to that help
• QPR training is $495 for 1 day training that allows the trainer to
offer it on campus.
http://www.qprinstitute.com/
43
Training and Outreach
safeTALK:
• safeTALK is suicide alertness for everyone and teaches
participants how to recognize when thoughts of suicide are
present & how to initiate alert steps to get some assistance.
• The TALK steps are Tell, Ask, Listen, and Keep Safe. The
training includes discussion of why persons might miss,
dismiss, or avoid the idea of suicide and offers participants
the opportunity to practice TALK steps.
• safeTALK participant cost: $6 resource book, pocket card,
sticker, and certificate. safeTALK training for trainers costs
$400-600 (cost is lower if you have 10 trainer candidates).
Trainer prerequisite is ASIST training.
www.livingworks.net
44
Advice Moving Forward
Invest in Case Management
• Counseling Center Models
• Administrative Models
–
–
–
–
–
–
Student Affairs
Behavioral Intervention Team
Student Conduct
Emergency Management
Provost’s Office/Academic Affairs
Human Resources
• Third party company as a fee-for-service
45
Advice Moving Forward
Understanding Level of Care
• Online support/paraprofessional (RA)/friend
• Consulting evaluation (stop by)
• Outpatient treatment:
– Weekly or bi-weekly
– Psychological Testing
– Medication Referrals
•
•
•
•
Case Management/Team meeting
Partial Day Treatment (1x/week)
Crisis Stabilization Unit
Inpatient Unit
46
Advice Moving Forward
A single event can have rippling effects throughout
the community
– Faculty in the classroom
– Residence hall/floor
– Athletic teams
– Clubs and organizations
– Family and parents
– Admissions and university PR
– Students that are already struggling “on the edge”
47
Advice Moving Forward
48
Advice Moving Forward
• Involve the student in the conversation
• Consider the individual student and look for common
goals for the student and the school (e.g. graduation,
good grades, financial aid eligibility)
• Look for ways to minimize or manage disruption,
rather than referring to the conduct process
• Involve family in a cooperative process; build
alliances
49
Advice Moving Forward
• Be flexible and generous with voluntary withdrawal
and incompletes, if possible
• Assist with office campus referrals – get everyone at
the table once
• Don’t lock the door once they leave
• Consistent risk assessment and intervention model
(including when to refer to conduct/counseling)
50
Advice Moving Forward
Know the limits and the opportunities of FERPA
– Determine who has a “legitimate educational interest”
in knowing information
– Value of interdisciplinary teams and approaches
– Empower the person that the student trusts
– Educate faculty and frontline staff
– Talk to parents . . .
AND to students
– Invite the people you need
to the table
– Create a culture of reporting
51
Don’t Do This
Things to avoid when working with suicidal students
– Take an ‘Us vs. Them’ approach
– See suicidal behavior like drinking violations
– Let FERPA/HIPAA and confidentiality law limit your
communications unnecessarily
– Adopt a ‘no parents’ approach
– Let students with mental health conditions ‘off the
hook’ when they violate a conduct code
– Coerce students into a voluntary leave by giving them
few options
52
Do This
Things to do when working with at-risk students
– Don’t be afraid of conversations
– Empower and support the faculty and staff with
whom the student has a relationship
– Involve parents/support early and often
– Assist and support students through medical
withdrawal options (academics, tuition, support)
– Create clear policies that show care for students
53
Questions?
Brian Van Brunt, Ed.D.
Senior Vice President of Professional Program Development
The NCHERM Group, LLC
[email protected]