Transcript Suicide Risk Assessment & School

Suicide Prevention in Schools:
Best Practices 2008
Stephen E. Brock, Ph.D., NCSP
California State University Sacramento
School Psychology Training Program
916 278-5919 / [email protected]
http://www.csus.edu/indiv/b/brocks/
Richard Lieberman NCSP
Los Angeles Unified School District
[email protected]
1
Workshop Outline

Suicide
1.
2.
3.
4.
5.
Statistics
Prevention
Risk Assessment
Intervention
Postvention
2
Workshop Goals

When you leave this workshop we hope that
you will have…
1.
2.
3.
4.
5.
a better understanding of the magnitude of the
problem of youth suicide.
considered a variety of suicide prevention
strategies.
increased your knowledge of suicide risk
assessment.
increased your knowledge of how schools should
intervene with the student at risk for suicidal
behavior.
increased your knowledge of how to respond to the
aftermath of a completed suicide.
3
Part 1
Introduction to the Problem of Suicide
GOAL:
Develop a better understanding of the magnitude of the problem
of youth suicide.
4
National Youth Suicide Statistics

Third leading cause of death among 10 to 24 year olds.*

16.9% of high school students report having seriously
considered suicide in the prior 12 months.**

13.0% report having made a suicide plan in the prior 12
months.**

8.4% of high school students report having attempted
suicide.**

2.3% indicating that the attempt required medical
attention.**

100 to 200 attempts for each completed suicide.***
*Fatal
Injury Reports, 2004, http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html
5
**Youth Risk Behavior Survey (2005), www.cdc.gov/HealthyYouth/yrbs/index.htm
***McIntosh (2006), Suicide Data Page, http://www.suicidology.org/displaycommon.cfm?an=1&subarticlenbr=21
Other Suicide Facts: All Age Groups
(2005 National Data)

Total number of deaths = 32,6371
 11th leading cause of death1

More men die by suicide1
 Gender ratio 3.8 male suicides (n = 25,907) for each females
suicide (n = 6,730)

Suicide Rate = 11.0/100,000 (males, 17.7; females, 4.5 [3.8:1])1

52.1% of suicides were by firearms.





Suicide
Suicide
Suicide
Suicide
by
by
by
by
firearms
firearms
firearms
firearms
1,3
rate
=
rate (15-19 yrs)
=
rate (15-19 yrs male) =
rate (15-19 yrs female) =
5.7
3.80
6.47
0.98
Highest suicide rate is among white men over 85 (48.42/100,0003 vs
8.25/100,0001 among 15-19 year olds3).

1McIntosh
However the 5th highest rate is among American Indian/Alaskan Native
15-19 year old males3.
(2008, January), Suicide Data Page, http://www.suicidology.org/displaycommon.cfm?an=1&subarticlenbr=21
M., Heron, M. P., Smith, B. L. (2006, June 28). Deaths: Final data for 2004. National Vital Statistics Reports, 54(19). 6
Hyattsville, MD: National Center for Health Statistics. www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19.pdf
3 National Center for Injury Prevention and Control (2004), http://webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html
2Minino, A.
US Suicide
Rates by State
Suicide Rate Ranges
15 to23
.6
12
.4 to15
11
.6 to12
.4
10
.2 to11
.6
6 to10
.2
(12)
(10)
(6)
(12)
(11)
7
Suicide Rates by State (2005 Data)
Rank
State (2004 rank)
1
Montana (2)
2
Nevada (2)
3
Alaska (1)
4
New Mexico (4)
4
Wyoming (5)
6
Colorado (6)
7
Idaho (7)
8
Arizona (11)
9
South Dakota (13)
10
Oregon (10)
42
California (42)
National Total
#
206
480
131
342
90
800
228
945
121
560
3,206
32,637
Rate
22.0
19.9
19.7
17.7
17.7
17.1
16.0
15.9
15.6
15.4
8.9
11.0 8
Source: McIntosh (2008)
Female Suicide Rates by Country
Female Suicide Rates
14
.4 to17
.9
10
.8 to14
.4
7.2 to10
.8
3.6 to 7.2
0 to 3.6
(4)
(10)
(15)
(19)
(40)
9
Male Suicide Rates by Country
Male Suicide Rates
58
.8 to73
.7
44
.1 to58
.8
29
.4 to44
.1
14
.7 to29
.4
0 to14
.7
(4)
(5)
(6)
(25)
(48)
10
US Suicide Rates by Age & Gender
(2004 data)
Suicide Rate
(per 100, 000)
50
45
40
35
30
25
\
20
15
10
5
0
5-9 yrs 10-14
yrs
15-19
yrs
20-24
yrs
25-29
yrs
30-34
yrs
35-39
yrs
Males
40-44
yrs
45-49
yrs
Females
50-54
yrs
55-59
yrs
60-64
yrs
65-69
yrs
Both Genders
70-74
yrs
75-79
yrs
80-84
yrs
85+
11
Source: NCIPC (2007)
World Suicide Rates by Age & Gender (2000
data)
Suicide Rate
(per 100, 000)
60
50
40
30
\
20
10
0
5-14 yrs
15-24 yrs
25-34 yrs
35-44 yrs
Males
45-54 yrs
55-64 yrs
Females
Source: WHO (2002)
65-74 yrs
75+ yrs
12
Male Suicide Rates by Age & Ethnicity
(2004 data)
(per 100,000)
60
50
Suicide Rate
40
30
20
10
0
05-09
yrs
10-14
yrs
15-19
yrs
White
20-24
yrs
25-29
yrs
Black
30-34
yrs
35-39
yrs
40-44
yrs
45-49
yrs
AmI nd/AK Native
50-54
yrs
55-59
yrs
60-64
yrs
65-69
yrs
70-74
yrs
Asian/Pac Islander
75-79
yrs
80-84
yrs
85+ yrs
All Groups
13
Source: NCIPC (2007)
Female Suicide Rates by Age & Ethnicity
(2004 data)
Suicide Rate (per 100,000)
16
14
12
10
8
6
4
2
0
05-09
yrs
10-14
yrs
15-19
yrs
20-24
yrs
25-29
yrs
30-34
yrs
White
Asian/Pac Islander
35-39
yrs
40-44
yrs
45-49
yrs
Black
All Groups
50-54
yrs
55-59
yrs
60-64
yrs
65-69
yrs
70-74
yrs
75-79
yrs
80-84
yrs
85+
AmI nd/AK Native
14
Source: NCIPC (2007)
15-19 Year Old Suicide Rates Over Time
Suicide Rate (per 100,000)
20
18
16
14
12
10
8
6
4
2
0
1950
1960
1970
Male
1980
1990
Female
Overall
2000
2004
15
Source: NCIPC (2007)
Percent1 of 9-12 Grade Students with
an Injurious Suicide2 Attempt (YRBS)
4
3.5
3
2.5
2
1.5
1
0.5
0
1991
1993
1995
Male
1Response
2A
1997
1999
Female
2001
2003
2005
Total
is for the 12 months preceding the survey
16
suicide attempt that required medical attention
Youth Risk Behavior Survey (2005)
Percent1 of 9-12 Grade Students with a
Suicide Attempt2 (YRBS)
14
12
Percent
10
8
6
4
2
0
1991
1993
1995
1997
Male
1999
Female
2001
2003
2005
Total
1Response
is for the 12 months preceding the survey
2A suicide attempt that did not necessarily require medical attention
17
Youth Risk Behavior Survey (2005)
Percent1 of 9-12 Grade Students with a
Suicide Plan2 (YRBS)
30
25
20
15
10
5
0
1991
1993
1995
1997
Male
1999
Female
2001
2003
2005
Total
1Response
is for the 12 months preceding the survey
2Thought about how they would attempt suicide
18
Youth Risk Behavior Survey (2005)
Percent1 of 9-12 Grade Students who
Seriously Considered Suicide (YRBS)
40
35
30
25
20
15
10
5
0
1991
1993
1995
1997
Male
1Response
1999
Female
2001
2003
2005
Total
is for the 12 months preceding the survey
19
Youth Risk Behavior Survey (2005)
Percent1 of 9-12 Grade Students who
felt sad or hopless2 (YRBS)
40
35
30
25
20
15
10
5
0
1999
2001
Male
1Response
2003
Female
2005
Total
is for the 12 months preceding the survey
2Almost every day for two weeks or more in a row and
20
as a result stopped doing some usual activities
Youth Risk Behavior Survey (2005)
Percent1 of 9-12 Grade Students who display
suicide related behaviors2 (YRBS)
35
30
Percent
25
20
15
10
5
0
1991 1993 1995 1997 1999 2001 2003 2005
Attempt w/ injury
Suicide Thoughts
1Response
Attempt w/o injury
Sad/Hopeless
is for the 12 months preceding the survey
2Both genders
Suicide Plan
21
Youth Risk Behavior Survey (2005)
Part 2
Suicide Prevention
GOAL:
Considered a variety of suicide prevention strategies.
22
Primary Prevention:
Suicide Prevention Policy
It is the policy of the Governing Board that all
staff members learn how to recognize students at
risk, to identify warning signs of suicide, to take
preventive precautions, and to report suicide
threats to the appropriate parental and
professional authorities.
Administration shall ensure that all staff members
have been issued a copy of the District's suicide
prevention policy and procedures. All staff
members are responsible for knowing and acting
upon them.
23
Primary Prevention:
Suicide Prevention Curriculum

SOS: Depression Screening and Suicide Prevention



http://www.mentalhealthscreening.org/highschool/
“The main teaching tool of the SOS program is a video
that teaches students how to identify symptoms of
depression and suicidality in themselves or their friends
and encourages help-seeking. The program's primary
objectives are to educate teens that depression is a
treatable illness and to equip them to respond to a
potential suicide in a friend or family member using the
SOS technique. SOS is an action-oriented approach
instructing students how to ACT (Acknowledge, Care and
Tell) in the face of this mental health emergency.”
Evidenced based!
24
Primary Prevention:1
Suicide Prevention Screening

School-wide Screening


Very few false negatives
Many false positives


Limitations




Requires second-stage evaluation
Risk waxes and wanes
Principals’ view of acceptability
Requires effective referral procedures
Possible Tool



Suicidal Ideation Questionnaire
Author: William Reynolds
Publisher: Psychological Assessment Resources
1Acknowledgement/Reference:
Gould, M. S., & Kramer, R. A. (2001). Youth suicide prevention. Suicide and
Life-Threatening Behavior, 31 (sup.), 6-31.
25
Primary Prevention:
Suicide Prevention Screening

http://www.teenscreen.org/
26
Primary Prevention:1
Suicide Prevention: Gatekeeper Training

Training natural community caregivers


Advantages



(e.g., Suicide Intervention Training)
Reduced risk of imitation
Expands community support systems
Research is limited but promising

Durable changes in attitudes, knowledge, intervention
skills
1Acknowledgement/Reference:
Gould, M. S., & Kramer, R. A. (2001). Youth suicide prevention. Suicide and
Life-Threatening Behavior, 31 (sup.), 6-31.
27
Primary Prevention:
Suicide Prevention: Gatekeeper Training
A Specific Training Program:

Applied Suicide Intervention Skills Training
 Author: Ramsay, Tanney, Tierney, & Lang
 Publisher: LivingWorks Education, Inc
 1-403-209-0242
 http://www.livingworks.net/

The ASIST workshop (formerly the Suicide Intervention
Workshop) is for caregivers who want to feel more
comfortable, confident and competent in helping to prevent
the immediate risk of suicide. Over 200,000 caregivers have
participated in this two-day, highly interactive, practical,
practice-oriented workshop.
Training for Trainers is a (minimum) five-day course that
prepares local resource persons to be trainers of the ASIST
workshop. Around the world, there is a network of 1000
active, registered trainers.

28
Primary Prevention:1
Suicide Prevention & Crisis Hotlines

Rationale





Suicidal ideation is associated with crisis
Suicidal ideation is associated with ambivalence
Special training is requires to respond to “cries for
help”
Likely benefit those who use them
Limitations




Limited research regarding effectiveness
Few youth use hotlines
Youth are less likely to be aware of hotlines
Highest risk youth are least likely to use
1Acknowledgement/Reference:
Gould, M. S., & Kramer, R. A. (2001). Youth suicide prevention. Suicide and
Life-Threatening Behavior, 31 (sup.), 6-31.
29
Suicide Prevention Resource

The Surgeon General’s Call to Action to
Prevent Suicide 1999
http://www.surgeongeneral.gov/library/calltoaction/default.htm
30
Part 3
Suicide Risk Assessment
GOAL:
Increase your knowledge of suicide risk assessment.
31
Myths and Facts Quiz (True or False)
1. If you talk to someone about their suicidal feelings
you will cause them to commit suicide.
2. When a person talks about killing himself, he's just
looking for attention. Ignoring him is the best thing
to do.
3. People who talk about killing themselves rarely
commit suicide.
4. All suicidal people want to die and there is nothing
that can be done about it.
5. If someone attempts suicide he will always entertain
thoughts of suicide.
6. Once a person tries to kill himself and fails, the pain
and humiliation will keep him from trying again.
Sources: Giffen, Mary, M.D. and Carol Felsenthal. A Cry For Help. Doubleday and Col, 1983.
Miller, Marv. Training Outline for Suicide Prevention. The Center for Information on Suicide. San Diego, California,32
1980.
Recognizing the Need for a Suicide
Risk Assessment

Risk Factors


Variables that signal the need to look for
warning signs of suicidal thinking.
Warning Signs

Variables that signal the possible presence
of suicidal thinking.
33
Suicide Intervention Risk Factors

Psychopathology
 Associated with 90% of suicides
 Prior suicidal behavior the best predictor
 Substance abuse increases vulnerability and
can also act as a trigger

Familial
 History
 Stressor
 Functioning
34
Suicide Intervention Risk Factors

Biological
 Reduced serotongenic activity

Situational
 40% have identifiable precipitants
 A firearm in the home
 By themselves are insufficient
 Disciplinary crisis most common
35
Variables That Enhance Risk






Adolescence and late
life
Bisexual or homosexual
gender identity
Criminal behavior
Cultural sanctions for
suicide
Delusions
Disposition of personal
property







Divorced, separated,
or single marital status
Early loss or
separation from
parents
Family history of
suicide
Hallucinations
Homicide
Hopelessness
Hypochondriasis
36
Suicide Intervention Warning Signs

Verbal



Most individuals give verbal clues that they
have suicidal thoughts.
Clues include direct ("I have a plan to kill
myself”) and indirect suicide threats (“I
wish I could fall asleep and never wake
up”).
Behavioral
37
Suicide Intervention Warning Signs

Verbal Clues
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
“Everybody would be better off if I just weren’t around.”
“I’m not going to bug you much longer.”
“I hate my life. I hate everyone and everything.”
“I’m the cause of all of my family’s/friend’s troubles.”
“I wish I would just go to sleep and never wake up.”
“I’ve tried everything but nothing seems to help.”
“Nobody can help me.”
“I want to kill myself but I don’t have the guts.”
“I’m no good to anyone.”
“If my (father, mother, teacher) doesn’t leave me alone
I’m going to kill myself.”
11. “Don’t buy me anything. I won’t be needing any (clothes,
38
books).”
Suicide Intervention Warning Signs

Behavioral Clues
1. Writing of suicidal notes
2. Making final arrangements
3. Giving away prized possessions
4. Talking about death
5. Reading, writing, and/or art about death
6. Hopelessness or helplessness
7. Social Withdrawal and isolation
8. Lost involvement in interests & activities
9. Increased risk-taking
10. Heavy use of alcohol or drugs
39
Suicide Intervention Warning Signs

Behavioral Clues (continued)
11. Abrupt changes in appearance
12. Sudden weight or appetite change
13. Sudden changes in personality or
attitude
14. Inability to concentrate/think rationally
15. Sudden unexpected happiness
16. Sleeplessness or sleepiness
17. Increased irritability or crying easily
18. Low self esteem
40
Suicide Intervention Warning Signs

Behavioral Clues (continued)
19. Dwindling academic performance
20. Abrupt changes in attendance
21. Failure to complete assignments
22. Lack of interest and withdrawal
23. Changed relationships
24. Despairing attitude
41
Asking the “S” Question
The presence of suicide warning signs,
especially when combined with suicide
risk factors generates the need to
conduct a suicide risk assessment.
 A risk assessment begins with asking if
the student is having thoughts of
suicide.

42
Identification of Suicidal Intent

Be direct when asking the “S” question.



BAD
 You’re not thinking of hurting yourself, are you?
Better
 Are you thinking of harming yourself?
BEST
 Sometimes when people have had
your experiences and feelings they
have thoughts of suicide. Is this
something that you’re thinking
about?
43
Predicting Suicidal Behavior (CPR++)
(Ramsay, Tanney, Lang, & Kinzel, 2004; )
 Current plan (greater planning = greater
risk).



How (method of attempt)?
How soon (timing of attempt)?
How prepared (access to means of attempt)?
 Pain (unbearable pain = greater risk)

How desperate to ease the pain?

Person-at-risk’s perceptions are key
 Resources (more alone = greater risk)

Reasons for living/dying?
 Can be very idiosyncratic
 Person-at-risk’s perceptions are key
44
Predicting Suicidal Behavior (CPR++)
(Ramsay, Tanney, Lang, & Kinzel, 2004)

(+) Prior Suicidal Behavior?



of self (40 times greater risk)
of significant others
An estimated 26-33% of adolescent suicide
victims have made a previous attempt
(American Foundation or Suicide Prevention, 1996).

(+) Mental Health Status?


history mental illness (especially mood
disorders)
linkage to mental health care provider
45
Risk Assessment and Referral

Suicide Risk Assessment Summary
46
Risk Assessment

Suicide intervention script
47
Interviewing the Suicidal Child

Questions to ask in the evaluation of suicidal risk in children
1. Suicidal fantasies or actions:
Have you ever thought of hurting yourself?
Have you ever threatened or attempted to hurt yourself?
Have you ever wished or tried to kill yourself?
Have you ever wanted to or threatened to commit
suicide?
2. Concepts of what would happen:
What did you think would happen if you tried to hurt or
kill yourself?
What did you want to have happen?
Did you think you would die?
Did you think you would have severe injuries?
48
Part 4
School-Based Suicide Intervention
GOAL:
Increase your knowledge of how schools should intervene
with the student at risk for suicidal behavior.
49
School-Based Suicide Intervention

General Staff Procedures


The actions all school staff members are
responsible for knowing and taking whenever
suicide warning signs are displayed.
Risk Assessment and Referral

The actions taken by school staff members
trained in suicide risk assessment and
intervention.
50
Suicide Intervention General Staff
Procedures

Responding to a Suicide Threat.

A student who has threatened suicide
must be carefully observed at all times
until a qualified staff member can conduct a
risk assessment. The following procedures
are to be followed whenever a student
threatens to commit suicide.
51
Suicide Intervention General Staff
Procedures
1. Stay with the student or designate another
staff member to supervise the youth constantly
and without exception until help arrives.
2. Under no circumstances should you allow the
student to leave the school.
3. Do not agree to keep a student's suicidal
intentions a secret.
4. If the student has the means to carry out the
threatened suicide on his or her person,
determine if he or she will voluntarily relinquish
it. Do not force the student to do so. Do
not place yourself in danger.
52
Suicide Intervention General Staff
Procedures
5.
6.
7.
8.
Take the suicidal student to the prearranged
room.
Notify the Crisis Intervention Coordinator
immediately.
Notify the Crisis Response Coordinator
immediately.
Inform the suicidal youth that outside help has
been called and describe what the next steps
will be.
53
Risk Assessment and Referral
1.
Identify Suicidal Thinking
2.
From Risk Assessment Data, Make Appropriate
Referrals
3. Risk Assessment Protocol
a) Conduct a Risk Assessment.
b) Consult with fellow school staff members regarding
the Risk Assessment.
c) Consult with County Mental Health.
54
Risk Assessment and Referral
4. Use risk assessment information and consultation guidance
to develop an action plan. Action plan options are as
follows:
A. Extreme Risk

If the student has the means of his or her threatened
suicide at hand, and refuses to relinquish such then
follow the Extreme Risk Procedures.
B. Crisis Intervention Referral

If the student's risk of harming him or herself is judged
to be moderate to high then follow the Crisis
Intervention Referral Procedures.
C. Mental Health Referral

If the student's risk of harming him or herself is judged
to be low then follow the Mental Health Referral
Procedures.
55
Risk Assessment and Referral
A. Extreme Risk
i. Call the police.
ii. Calm the student by talking and reassuring
until the police arrive.
iii. Continue to request that the student
relinquish the means of the threatened
suicide and try to prevent the student from
harming him-or herself.
iv. Call the parents and inform them of the
actions taken.
56
Risk Assessment and Referral
B. Crisis Intervention Referral
i. Determine if the student's distress is the
result of parent or caretaker abuse,
neglect, or exploitation.
ii. Meet with the student's parents.
iii. Determine what to do if the parents are
unable or unwilling to assist with the
suicidal crisis.
iv. Make appropriate referrals.
57
Risk Assessment and Referral
C. Mental Health Referral
i. Determine if the student's distress is the
result of parent or caretaker abuse, neglect,
or exploitation.
ii. Meet with the student's parents.
iii. Make appropriate referrals.
• Protect the privacy of the student and
family.
• Follow up with the hospital or clinic.
58
Part 5
School-Based Suicide Postvention
GOAL:
increased your knowledge of how to respond to the aftermath
of a completed suicide.
59
Definitions

Suicide “Postvention”...
Postvention is the provision of crisis intervention,
support and assistance for those affected by a
completed suicide.

“Affected” individuals...
“Affected” individuals may include classmates, friends,
teachers, counselors, and family members.

“Survivors” of Suicide...
Affected individuals are often referred to as “survivors”
of suicide.
60
Preface
 “…the
largest public health problem
is neither the prevention of suicide
nor the management of suicide
attempts, but the alleviation of the
effects of stress on the survivors
whose lives are forever altered.”
E. S. Shneidman
Forward to Survivors of Suicide
Edited by A. C. Cain
Published by Thomas, 1972
61
Preface

Based on the 754,570 suicides from 1980
to 2004, it is estimated that the number of
survivors of suicides in the U.S. is 4.5
million (1 of every 65 Americans in 2004).
This number grew by at least 194,634 in
2004.
John L. McIntosh (2006), Suicide Data Page,
http://www.suicidology.org/displaycommon.cfm?an=1&subarticlenbr=21
62
Special Suicide Postvention Issues
1.
Suicide Contagion

Avoid sensationalism of the suicide.

Avoid glorification or vilification of the suicide victim.

Do not provide excessive details.
2.
Emotional Response

Guilt and shame
3.
Social Experience

Rejection and isolation
4. Suicide Bereavement Response/Experience (vs. naturally
bereaved; De Groot et al., 2006)

Poorer physical, emotional, and social functioning
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Special Suicide Postvention Issues
5. Social Stigma




Both students and staff members may be uncomfortable
talking about the death.
Survivors may receive (and/or perceive) much less social
support for their loss.
Approximately half of survivors close friends report a more
strained/distant relationship (Norford, 2005).
Reluctance to provide postvention services.
Suicide postvention must be prepared to operate in an
environment that is not only suffering from a sudden
and unexpected loss, but one that is also anxious
talking openly about the death.
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Developmental Issues
1. It is not until the fifth grade that students
have a clear understanding of what the term
“suicide” means and are aware that it is a
psychosocial dynamic that leads to suicidal
behavior.
2. While primary grade children appear to
understand the concept of “killing oneself,”
they typically do not recognize the term
“suicide” and generally do not understand the
dynamics that lead to this behavior.
3. The risk of suicidal ideation and behaviors
increases as youth progress through the
school years.
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Cultural Issues

Attitudes toward suicidal behavior vary
considerably from culture to culture.

While some cultures may view suicide as
appropriate under certain
circumstances, other have strong
sanctions against all such behavior.
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General Suggestions for Helping Survivors

Both survivors and educators need
support.

Survivors need …
 support groups.
 support from outside of the family.
 to be educated about the
psychodynamics of grieving.
 to be contacted in person instead of
by letter or by phone after the suicide
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Grad et al., 2004
General Suggestions for Helping Survivors
Awareness among educators of the needs
of survivors.
 Using someone as a scapegoat does not
help.
 Educate school-based mental health
professionals how to support survivors
and support each other.


“It is absolutely necessary to train
professionals, firstly to acknowledge their own
feelings, and secondly to cope with them after
the loss of their patient” (p. 139).
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Grad et al., 2004
Suicide Postvention Protocol
1. Preparedness is an essential
component of effective postvention.
2. Make sure that a postvention is needed
before initiating this intervention.
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Suicide Postvention Checklist
1. Verify that a death has occurred.
2. Mobilize the Crisis Response Team.
3. Assess the suicide’s impact on the school and estimate the
level of postvention response.
4. Notify other involved school personnel.
5. Contact the family of the suicide victim.
6. Determine what information to share about the death.
7. Determine how to share information about the death.
8. Identify students significantly affected by the suicide and
initiate a referral mechanism.
9. Conduct a faculty planning session.
10. Initiate crisis intervention services.
11. Conduct daily planning sessions.
12. Memorials.
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13. Debrief the postvention response.
Item 2:
Mobilize the Crisis Response Team
Crisis Response Coordinator



Verifies that at death has occurred.
Mobilizes the crisis response team.
Oversees all postvention interventions.
Crisis Intervention Coordinator



Identifies individuals in need of postvention assistance.
Plans and implements interventions.
Coordinates crisis intervention workers.
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Item 2:
Mobilize the Crisis Response Team
Media Liaison



Provides access to information.
Controls rumors.
Deals with the media.
Medical Liaison

Keeps the crisis response team informed of victim’s
medical status.
Security Liaison



Responsible for crowd control.
Monitors common areas.
Communicates with law enforcement.
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Item 3:
Assess the Suicide’s Impact on the School and
Estimate the Level of Postvention Response

The importance of accurate estimates.

Temporal proximity to other traumatic
events (especially suicides).


Timing of the suicide.
Physical and/or emotional proximity to
the suicide.
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Item 5:
Contact the Family of the Suicide Victim
1. Contact should be made in person within
24 hours of the death.
2. Purposes include...





Express sympathy.
Offer support.
Identify the victim’s friends who may need
assistance.
Discuss the school’s postvention response.
Identify details about the death could be
shared with outsiders.
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Item 6:
Determine What Information to Share About the Death
1. The longer the delay in sharing facts, the
greater the likelihood of harmful rumors.
2. Several different communications will likely need
to be offered.
 Before a death is certified as a suicide.
 After a death is certified as a suicide.
 Provide facts and dispel rumors.
 Do not provide suicide method details.
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Item 7:
Determine How to Share Information About the Death
1. Reporting the death to students...



Avoid sharing information about the death over a
school's public address system.
Avoid school wide assemblies.
Provide information simultaneously in classrooms.
2. Reporting the death to parents...


Written memos.
Personal or phone contacts.
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Item 7:
Determine How to Share Information About the Death
Working with the media...
 The Media Liaison should work with the press
to down play the incident .
 It is essential that the media not romanticize
the death.
 The media should be encouraged to
acknowledge the pathological aspects of
suicide.
 Photos of the suicide victim should not be
used.
 “Suicide" should not be placed in the caption .
 Include information about the community
resources.
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Item 8:
Identify Students Significantly Affected by the Suicide
and Initiate Referral Procedures
Risk Factors for Imitative Behavior










Facilitated the suicide.
Failed to recognize the suicidal intent.
Believe they may have caused the suicide.
Had a relationship with the suicide victim.
Identify with the suicide victim.
Have a history of prior suicidal behavior.
Have a history of psychopathology.
Shows symptoms of helplessness and/or hopelessness.
Have suffered significant life stressors or losses.
Lack internal and external resources.
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Note. Adapted from information provided by American Association of Suicidology (1998); Brent et al. (1989); Davidson (1989); Davidson,
Rosenberg, Mercy, Franklin, & Simmons (1989); Gould (1992); O'Carroll et al. (1988); Ruof and Harris (1988); and Sandoval & Brock (1996).
Item 9:
Conduct a Staff Planning Session
1. Staff should be provided...





current information regarding the death.
if available, news articles about the death.
information about suicide contagion.
suicide risk factors.
plans for the provision of crisis intervention
services.
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Item 9:
Conduct a Staff Planning Session
2. Specific activities/responsibilities for
teachers include...






replacing rumors with facts.
encouraging the ventilation of feelings.
stressing the normality of grief and stress reactions.
discouraging attempts to romanticize the suicide.
identifying students at risk for an imitative response.
knowing how to make the appropriate referrals.
3. Address staff reactions.
4. Staff members should be given
permission to feel uncomfortable.
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Item 10:
Initiate Crisis Intervention Services
1. Intervention options...
 Individual meetings.
 Group psychological first aid.
 Classroom activities and/or presentations.
 Parent meetings.
 Staff meetings.
 Referrals to community agencies.
2. Walk through the suicide victim’s class
schedule.
3. Meet separately with individuals who were
proximal to the suicide.
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Item 10:
Initiate Crisis Intervention Services
4. Identify severely traumatized and make
appropriate referrals.
5. Facilitate dis-identification with the suicide
victim...
 Do not romanticize or glorify the victim's
behavior or circumstances.
 Point out how students are different from
the victim.
6. Parental contact.
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Crisis Intervention Procedures Following a Suicide
1.
2.
3.
4.
5.
Without excessive detail, provide students with the facts
about the suicide.
State that the only one ultimately responsible for the suicide
is the victim.
Acknowledge the suicide was an avoidable and poor choice.
 Portray the act as a permanent solution to temporary
problems.
Discuss how survivors are different from the suicide victim.
 Portray the suicide victim as very upset, disturbed, and as
someone who had not found an effective way to work out
problems.
 Help survivors to dis-identify with the suicide victim
(without abusing the victim's character).
Facilitate the expression of feelings about the suicide.
Adapted from information provided by American Association of Suicidology (1998); Berman & Jobes (1991); Davis & Sandoval (1991);
83
O’Carroll et al. (1988); Poland & McCormick (1999); and Ruof and Harris (1988).
Crisis Intervention Procedures Following a Suicide
6. State that there is no “right way” to feel after a
suicide.
7. Point out that painful reactions to the suicide will
be alleviated with time and talk.
8. Acknowledge that people may have suicidal
thoughts following the suicide of a significant other.
9. Provide information about the warning signs of
suicidal behavior and available mental health
resources.
10. If appropriate, prepare students for the funeral.
Adapted from information provided by American Association of Suicidology (1998); Berman & Jobes (1991); Davis 84
& Sandoval (1991); O’Carroll et al. (1988); Poland & McCormick (1999); and Ruof and Harris (1988).
Item 12:
Memorials
Do not . . .
 send all students from school to funerals, or
stop classes for a funeral.
 have memorial or funeral services at school.
 put up plaques in memory of the suicide
victim, or dedicate yearbooks, songs, or
sporting events to the suicide victims.
 fly the flag at half staff.
 have assemblies focusing on the suicide
victim, or have a moment of silence in allschool assemblies.
From “Suicidal Ideation and Behaviors” (p. 327), by S. E. Brock & J. Sandoval. In C. G. Bear, K. M. Minke, & A. Thomas, Children’s
85
Needs II: Development, Problems, and Alternatives, 1997, Bethesda, MD: National Association of School Psychologists. Copyright 1997 by
the National Association of School Psychologists. Adapted with permission.
Item 12:
Memorials
Do . . .
 something to prevent other suicides.
 develop living memorials, such as student
assistance programs, that will help others
cope with feelings and problems.
 allow students, with parental permission, to
attend the funeral.
 encourage affected students, with parental
permission, to attend the funeral.
 mention to families and ministers the need to
distance the person who committed suicide
from survivors and to avoid glorifying the
suicidal act.
From “Suicidal Ideation and Behaviors” (p. 327), by S. E. Brock & J. Sandoval. In C. G. Bear, K. M. Minke, & A. Thomas, Children’s
86
Needs II: Development, Problems, and Alternatives, 1997, Bethesda, MD: National Association of School Psychologists. Copyright 1997
by the National Association of School Psychologists. Adapted with permission.
Item 13:
Debrief the Postvention Response
Goals will include...

Review and evaluation of all crisis intervention
activities.

Making of plans for follow-up actions.

Providing an opportunity to help intervenors
cope.
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Suicide Postvention Resources

Handout
88
Concluding Thought

“…the person who commits suicide puts his
psychological skeleton in the survivor’s emotional
closet; he sentences the survivor to deal with
many negative feelings and more, to become
obsessed with thoughts regarding the survivor’s
own actual or possible role in having precipitated
the suicidal act or having failed to stop it. It can
be a heavy load.” (p. 154)
E. S. Shneidman (2001)
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Suicide Prevention in Schools:
Best Practices 2008
Stephen E. Brock, Ph.D., NCSP
California State University Sacramento
School Psychology Training Program
916 278-5919 / [email protected]
http://www.csus.edu/indiv/b/brocks/
Richard Lieberman, NCSP
Los Angeles Unified School District
[email protected]
90