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Duval County Schools

Jacksonville Public Schools
Mental Health & Suicide Prevention

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– Karen Musante, President, PFEW

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After a Teen Suicide:

Plan of Action for Schools

Suicide in a school community is tremendously sad, often unexpected, and can leave a school with many uncertainties about what to do next.  Faced with students struggling to cope and a community struggling to respond, schools need reliable information, practical tools, and pragmatic guidance.

Important Principles to note:

  1. Schools should strive to treat all student deaths in the same way. Having one approach for a student who dies of cancer (for example) and another for a student who dies by suicide reinforces the unfortunate stigma that still surrounds suicide and may be deeply and unfairly painful to the deceased student’s family and close friends.
  2. At the same time, schools should be aware that adolescents are vulnerable to the risk of suicide contagion. It is important not to inadvertently simplify, glamorize, or romanticize the student or his/her death.
  3. Schools should emphasize that the student who died by suicide was likely struggling with a mental disorder, such as depression or anxiety, that can cause substantial psychological pain but may not have been apparent to others (or that may have shown as behavior problems or substance abuse).
  4. Help is available for any student who may be struggling with mental health issues or suicidal feelings.

Crisis Response

A suicidal death in a school community requires implementing a coordinated crisis response to assist staff, students, and families who are impacted by the death and to restore an environment focused on education.  Whether or not there is a Crisis Response Plan already in place, the toolkit contains information that can be used to initiate a coordinated response once the basic facts about the death have been obtained.  Included are a Team Leader’s Checklist (who does what), talking points for use with students, staff, parents, and the media; sample handouts; meeting guidelines; and links to additional resources.

Helping Student Cope

Most adolescents have mastered basic skills that allow them to handle strong emotions encountered day to day, but these skills may be challenged in the face of a school suicide.  Moreover, adolescence marks a time of increased risk for difficulties with emotional regulation, given the intensification of responses that come with puberty and the structural changes in the brain that occur during this developmental period.  Schools should provide students with appropriate opportunities to express their emotions and identify strategies for managing them, so that the school can return to its primary focus of education.

Working with the Community

Because schools exist within the context of a larger community is important that in the aftermath of a suicide (or other death) the school administrative team establish open lines of communication with community partners such as the coroner/medical examiner, police department, mayor’s office, funeral director, clergy, and mental health professionals.  This collaborative approach allows for the sharing of important information and coordination of strategies.  A coordinated approach can be especially critical when the suicide receives a great deal of media coverage and when the community is looking to the school for guidance, support, answers, and leadership.

Memorialization

School communities often wish to memorialize a student who has died, reflecting a basic human desire to remember those we have lost. It can be challenging for schools to strike a comfortable balance between compassionately meeting the needs of distraught students while preserving the ability of the school to fulfill its primary purpose of education. In the case of suicide, schools must also consider how to appropriately memorialize the student who has died without risking suicide contagion among those surviving students who may themselves be at risk. It is very important that schools strive to treat all deaths in the same way.

Social Media

Social media such as texting, Facebook, and Twitter are rapidly becoming the primary means of communication for people of all ages, especially youth. While these communications generally take place outside of school (and may therefore fall outside of the school’s control or jurisdiction), they can nevertheless be utilized as part of the school’s response after a student’s suicide. By working in partnership with key students to identify and monitor the relevant social networking sites, schools can strategically use social media to share prevention-oriented safe messaging, o er support to students who may be struggling to cope, and identify and respond to students who could be at risk themselves.

Suicide Contagion

Contagion is the process by which one suicide may contribute to another. In fact, in some cases suicide(s) can even follow the death of a student from other causes, such as an accident. Although contagion is comparatively rare (accounting for between 1 percent and 5 percent of all suicide deaths annually), adolescents appear to be more susceptible to imitative suicide than adults, largely because they may identify more readily with the behavior and qualities of their peers. If there appears to be contagion, school administrators should consider taking additional steps beyond the basic crisis response, including stepping up e orts to identify other students who may be at heightened risk of suicide, collaborating with community partners in a coordinated suicide prevention effort, and possibly bringing in outside experts.

Bringing in Outside Help

School crisis team members should remain mindful of their own limitations and consider bringing in trained trauma responders from other school districts or local mental health centers to help them as needed.

Going Forward

In the ensuing months, schools may wish to consider implementing suicide awareness programs to educate teachers, other school personnel, and students themselves.

Get the Facts First

In the event of a possible suicide death within a school community, it is critical that the school first obtain confirmed and accurate information.

Key Consideration

While it may not always be possible to immediately ascertain all of the details about the death, confirming as much information as possible is important because speculation and rumors can exacerbate emotional upheaval within the school. If the cause of death has not been confirmed to be suicide, if there is an ongoing investigation, or if the family does not want the cause of death disclosed, it can be challenging for a school to determine how to proceed.

Confirm the Cause of Death

The school’s principal or superintendent should first check with the coroner and/or the medical examiner’s office (or, if necessary, local law enforcement) to ascertain the official cause of death. If the death has been ruled a suicide, the school can proceed to communicate as described in the crisis response section.

If the Cause of Death is Unconfirmed

If the body has not yet been recovered or if there is an ongoing investigation, schools should state that the cause of death is still being determined and that additional information will be forthcoming once it has been confirmed. Acknowledge that there are rumors (which are often inaccurate), and remind students that rumors can be deeply hurtful and unfair to the missing/ deceased person, their family, and their friends.

If there is an ongoing investigation, schools should check with local law enforcement before speaking about the death with students who may need to be interviewed by the authorities.

If the Family Does Not Want the Cause of Death Disclosed

While the fact that a student has died may be disclosed immediately, information about the cause of death should not be disclosed to students until the family has been consulted. If the death has been declared a suicide but the family does not want it disclosed, someone from
the administration or counseling staff who has a good relationship with the family should be designated to contact them to explain that students are already talking about the death amongst themselves, and that having adults in the school community talk to students about suicide and its causes can help keep students safe.

If the family refuses to permit disclosure, schools can state, “The family has requested that information about the cause of death not be shared at this time” and can nevertheless use the opportunity to talk with students about the phenomenon of suicide: “We know there has been a lot of talk about whether this was a suicide death. Since the subject of suicide has been raised, we want to take this opportunity to give you accurate information about suicide in general, ways to prevent it, and how to get help if you or someone you know is feeling depressed or may be suicidal.”

Crisis Response

Once a suicide death has been confirmed, the school should immediately implement a coordinated crisis response in order to effectively manage the situation, provide opportunities for grief support, maintain an environment focused on normal educational activities, help students cope with their feelings, and minimize the risk of suicide contagion. What follows can be used by any school, regardless of whether there is a pre-existing Crisis Response Plan in place.

Key Considerations

The Crisis Response Team Leader (usually the school psychologist or counselor) has overall responsibility for the duration of the crisis. She or he should immediately assemble a Crisis Response Team, which will be responsible for implementing the various elements of the crisis response.

The Crisis Response Team should be composed of at least five or six (but no more than 15) people chosen for their skills, credentials, and ability to work compassionately and effectively under pressure—ideally a combination of administrators, counselors, social workers, psychologists, nurses, and/or school resource officers. It can also be useful to include a member of the school’s information technology or computer lab staff.

The Crisis Response Team Leader should designate one individual as the Team Coordinator.

Crisis Response Team Leader’s Checklist

  1. Inform the school superintendent of the death. 
  2. Contact the deceased’s family to offer condolences, inquire what the school can do to assist, discuss what students should be told, and inquire about funeral arrangements. 
  3. Call an immediate meeting of the Crisis Response Team to assign responsibilities. 
  4. Establish a plan to immediately notify faculty and staff of the death via the school’s crisis alert system (usually phone or e-mail). 
  5. Schedule an initial all-staff meeting as soon as possible (ideally before school starts in the morning). 
  6. Arrange for students to be notified of the death in small groups such as homerooms or advisories (not by overhead announcement or in a large assembly) and disseminate a death notification statement for students to homeroom teachers, advisors, or others leading those groups. 
  7. Draft and disseminate a death notification statement for parents. 
  8. Disseminate handouts on Facts About Suicide and Mental Disorders in Adolescents and Talking About Suicide to faculty. 
  9. Speak with school superintendent and Crisis Response Team Coordinator throughout the day. 
  10. Determine whether additional grief counselors, crisis responders, or other resources may be needed from outside the school. 

Team Coordinator’s Checklist

The tasks below may be delegated as appropriate to specific staff or faculty in the school.

  1. Conduct initial all-staff meeting.
  2. Conduct periodic meetings for the Crisis Response Team members. 
  3. Monitor activities throughout school, making sure teachers, staff , and Crisis Response Team members have adequate support and resources. 
  4. Plan parent meeting if necessary. 
  5. Assign roles and responsibilities to Crisis Response Team members in the areas of Safety, Operations, Community Liaisons, Funeral, Media Relations, and Social Media. 

Safety

  1. Keep to regular school hours. 
  2. Ensure that students follow established dismissal procedures. 
  3. Call on school resource officers or plant manager to assist parents and others who may show up at the school and to keep media o of school grounds. 
  4. Pay attention to students who are having particular difficulty, including those who may be congregating in hallways and bathrooms, and encourage them to talk with counselors or other appropriate school personnel. 

 Operations

  1. Assign a staff or faculty member to follow the deceased student’s schedule to monitor peer reactions and answer questions. 
  2. If possible, arrange for several substitute teachers or “ oaters” from other schools within the district to be on hand in the building in case teachers need to take time out oftheir classrooms. 
  3. Arrange for crisis counseling rooms for staff and students. 
  4. Provide tissues and water throughout the building and arrange for food for faculty and crisis counselors. 
  5. Work with administration, faculty, and counselors to identify individuals who may be having particular difficulty, such as family members, close friends, and teammates; those who had difficulties with the deceased; those who may have witnessed the death; and students known to have depression or prior suicidality; and work with school counseling staff to develop plans to provide psychological first aid to them. 
  6. Prepare to track and respond to student and/or family requests for memorialization. 

Community Liaison

  1. Several Team members will be needed, each serving as the primary contact for working with community partners of various types, including: coroner/medical examiner, to ensure accuracy of information disseminated to school community police, as necessary, to ensure student safety 
  2. Mayor’s office and local government, to facilitate community-wide response to the suicide death
  3. Mental health and medical communities, as well as grief support organizations, to plan for service needs
  4. Arranging for outside trauma responders and briefing them as they arrive on scene

Funeral

  1. Communicate with the funeral director about logistics, including the need for crisis counselors and/or security to be present at the funeral. Encourage family to consider holding the funeral o school grounds and outside of school hours if at all possible. 
  2. Discuss with the family the importance of communicating with clergy or whomever will be conducting the funeral to emphasize the importance of connecting suicide to underlying mental health issues (such as depression) and not romanticizing the death in ways that could risk contagion. 
  3. Depending on the family’s wishes, help disseminate information about the funeral to students, parents and staff, including:
  4. Location 
  5. Time of the funeral (keep school open if the funeral is during school hours) 
  6. What to expect (for example, whether there will be an open casket) 
  7. Guidance regarding how to express condolences to the family 
  8. Policy for releasing students during school hours to attend (i.e., students will be released only with permission of parent, guardian, or designated adult) 
  9. Work with school counselors and community mental health professionals to arrange for counselors to attend the funeral. 
  10. Encourage parents to accompany their child to the funeral. 

Media Relations

  1. Prepare a media statement.
  2. Designate a media spokesperson who will field media inquiries utilizing Key Messages for Media Spokesperson document.
  3. Advise staff that only the media spokesperson is authorized to speak to the media.
  4. Advise students to avoid interviews with the media.
  5. Refer media outlets to Reporting on Suicide: Recommendations for the Media.

Social Media

  1. Oversee school’s use of social media as part of the crisis response.
  2. Consider convening a small group of the deceased’s friends to work with school administration to monitor social networking sites and other social media. 

Agenda for Initial All-Staff Meeting

This meeting is typically conducted by the Crisis Response Team Leader and should be held as soon as possible, ideally before school starts in the morning.

Depending on when the death occurs, there may not be enough time to hold the meeting before students have begun to hear the news through word of mouth, text messaging, or other means. If this happens, the Crisis Response Team Leader should First verify the accuracy of the reports and then notify staff of the death through the school’s predetermined crisis alert system, such as e-mail or calls to classroom phones. Remember that information about the cause of death should be withheld until the family has been consulted.

Goals of Initial Meeting

Allow at least one hour to address the following goals:

  1. Introduce the Crisis Response Team members. 
  2. Share accurate information about the death. 
  3. Allow staff an opportunity to express their own reactions and grief. Identify anyone who may need additional support and refer them to appropriate resources. 
  4. Provide appropriate faculty (e.g., homeroom teachers or advisors) with a scripted death notification statement for students. Arrange coverage for any staff who are unable to manage reading the statement. 
  5. Prepare for student reactions and questions by providing handouts to staff on Talking About Suicide and Facts About Suicide and Mental Disorders in Adolescents. 
  6. Explain plans for the day, including locations of crisis counseling rooms. 
  7. Remind all staff of the important role they may play in identifying changes in behavior among the students they know and see every day, and discuss plan for handling students who are having difficulty. 
  8. Brief staff about identifying and referring at-risk students as well as the need to keep records of those e orts. 
  9. Apprise staff of any outside crisis responders or others who will be assisting
  10. Remind staff of student dismissal protocol for funeral. 
  11. Identify which Crisis Response Team member has been designated as the media spokesperson and instruct staff to refer all media inquiries to him or her. 

End of the First Day

It can also be helpful for the Crisis Response Team Leader and/or the Team Coordinator to have an all- staff meeting at the end of the first day. This meeting provides an opportunity to take the following steps: 

  1. Offer verbal appreciation of the staff. 
  2. Review the day’s challenges and successes. 
  3. Debrief, share experiences, express concerns, and ask questions. 
  4. Check in with staff to assess whether any of them need additional support, and refer accordingly. 
  5. Disseminate information regarding the death and/or funeral arrangements. 
  6. Discuss plans for the next day. 
  7. Remind staff of the importance of self-care. 
  8. Remind staff of the importance of documenting crisis response escorts for future planning and understanding. 

Sample Death Notification Statement for Students

Use in small groups such as homerooms or advisories, not in assemblies or over loudspeakers.

Option 1 – When the death has been ruled a suicide

It is with great sadness that I have to tell you that one of our students, _________, has taken [his/her] own life. All of us want you to know that we are here to help you in any way we can.

A suicide death presents us with many questions that we may not be able to answer right away. Rumors may begin to circulate, and we ask that you not spread rumors you may hear. We’ll do our best to give you accurate information as it becomes known to us.

Suicide is a very complicated act. It is usually caused by a mental disorder such as depression, which can prevent a person from thinking clearly about his or her problems and how to solve them. Sometimes these disorders are not identified or noticed; in other cases, a person with a disorder will show obvious symptoms or signs. One thing is certain: there are treatments that can help. Suicide should never, ever be an option.

Each of us will react to _____’s death in our own way, and we need to be respectful of each other. Feeling sad is a normal response to any loss. Some of you may not have known ______very well and may not be as affected, while others may experience a great deal of sadness. Some of you may find you’re having difficulty concentrating on your schoolwork, and others may find that diving into your work is a good distraction.

We have counselors available to help our school community deal with this sad loss and to enable us to understand more about suicide. If you’d like to talk to a counselor, just let your teachers know.

Please remember that we are all here for you.

Option 2 – When the cause of death is unconfirmed

It is with great sadness that I have to tell you that one of our students, _________, has died. All of us want you to know that we are here to help you in any way we can.

The cause of death has not yet been determined by the authorities. We are aware that there has been some talk about the possibility that this was a suicide death. Rumors may begin to circulate, and we ask that you not spread rumors since they may turn out to be inaccurate and can be deeply hurtful and unfair to _______ as well as [his/her] family and friends. We’ll do our best to give you accurate information as it becomes known to us.

Each of us will react to _____’s death in our own way, and we need to be respectful of each other. Feeling sad is a normal response to any loss. Some of you may not have known _____ very well and may not be as a effected, while others may experience a great deal of sadness. Some of you may find you’re having difficulty concentrating on your schoolwork, and others may find that diving into your work is a good distraction. We have counselors available to help our school community deal with this sad loss. If you’d like to talk to a counselor, just let your teachers know.

Please remember that we are all here for you.

Option 3 – When the family has requested that the cause of death not be disclosed

It is with great sadness that I have to tell you that one of our students, _________, has died. All of us want you to know that we are here to help you in any way we can.

The family has requested that information about the cause of death not be shared at this time.

We are aware that there has been some talk about the possibility that this was a suicide death. Rumors may begin to circulate, and we ask that you not spread rumors since they may turn out to be inaccurate and can be deeply hurtful and unfair to ______ as well as [his/her] family and friends. We’ll do our best to give you accurate information as it becomes known to us.

Since the subject has been raised, we do want to take this opportunity to remind you that suicide, when it does occur, is a very complicated act. It is usually caused by a mental disorder such as depression, which can prevent a person from thinking clearly about his or her problems and how to solve them. Sometimes these disorders are not identified or noticed; in other cases a person with a disorder will show obvious symptoms or signs. One thing is certain: there are treatments that can help. Suicide should never, ever be an option.

Each of us will react to _____’s death in our own way, and we need to be respectful of each other. Feeling sad is a normal response to any loss. Some of you may not have known ______very well and may not be as affected, while others may experience a great deal of sadness. Some of you may find you’re having difficulty concentrating on your schoolwork, and others may find that diving into your work is a good distraction. We have counselors available to help our school community deal with this sad loss. If you’d like to talk to a counselor, just let your teachers know.

Please remember that we are all here for you.

Sample Death Notification Statement for Parents

To be sent by e-mail or regular mail.

Option 1 – When the death has been ruled suicide

I am writing with great sadness to inform you that one of our students, ________, has died. Our thoughts and sympathies are with [his/her] family and friends.

All of the students were given the news of the death by their teacher in [advisory/homeroom] this morning. I have included a copy of the announcement that was read to them.

The cause of death was suicide. We want to take this opportunity to remind our community that suicide is a very complicated act. It is usually caused by a mental disorder such as depression, which can prevent a person from thinking clearly about his or her problems and how to solve them. Sometimes these disorders are not identified or noticed; other times, a person with a disorder will show obvious symptoms or signs. I am including some information that may be helpful to you in discussing suicide with your child.

Members of our Crisis Response Team are available to meet with students individually and in groups today as well as over the coming days and weeks. Please contact the school office if you feel your child is in need of additional assistance; we have a list of school and community mental health resources.

Information about the funeral service will be made available as soon as we have it. If your child wishes to attend, we strongly encourage you to accompany him or her to the service. If the funeral is scheduled during school hours, students who wish to attend will need parental permission to be released
from school.

The school will be hosting a meeting for parents and others in the community at 2022. Members of our Crisis Response Team [or mental health professionals] will be present to provide information about common reactions following a suicide and how adults can help youths cope. ey will also provide information about suicide and mental illness in adolescents, including risk factors and warning signs of suicide, and will address attendees’ questions and concerns.

Please do not hesitate to contact me or one of the school counselors with any questions or concerns.

Sincerely,[Principal]

Option 2 – When the cause of death is unconfirmed

I am writing with great sadness to inform you that one of our students, ________, has died. Our thoughts and sympathies are with [his/her] family and friends.

All of the students were given the news of the death by their teacher in [advisory/homeroom] this morning. I have included a copy of the announcement that was read to them.

The cause of death has not yet been determined by the authorities. We are aware that there has been some talk about the possibility that this was a suicide death. Rumors may begin to circulate, and we have asked the students not to spread rumors since they may turn out to be inaccurate and can be deeply hurtful and unfair to _______ as well as [his/her] family and friends. We’ll do our best to give you accurate information as it becomes known to us.

Members of our Crisis Response Team are available to meet with students individually and in groups today as well as over the coming days and weeks. Please contact the school office if you feel your child is in need of additional assistance; we have a list of school and community mental health resources.

Information about the funeral service will be made available as soon as we have it. If your child wishes to attend, we strongly encourage you to accompany him or her to the service. If the funeral is scheduled during school hours, students who wish to attend will need parental permission to be released from school.

Please do not hesitate to contact me or one of the school counselors with any questions or concerns.

Sincerely,[Principal]

Option 3 – When the family has requested that the cause of death not be disclosed

I am writing with great sadness to inform you that one of our students, ________, has died. Our thoughts and sympathies are with [his/her] family and friends.

All of the students were given the news of the death by their teacher in [advisory/homeroom] this morning. I have included a copy of the announcement that was read to them.

The family has requested that information about the cause of death not be shared at this time. We are aware that there have been rumors that this was a suicide death. Since the subject has been raised, we want to take this opportunity to remind our community that suicide, when it does occur, is a very complicated act. It is usually caused by a mental disorder such as depression, which can prevent a person from thinking clearly about the problems in his or her life and how to solve them. Sometimes these disorders are not identified or noticed; other times, a person with a disorder will show obvious symptoms or signs.

Members of our Crisis Response Team are available to meet with students individually and in groups today as well as over the coming days and weeks. Please contact the school office if you feel your child is in need of additional assistance; we have a list of additional school and community mental health resources.

Information about the funeral service will be made available as soon as we have it. If your child wishes to attend, we strongly encourage you to accompany him or her to the service. If the funeral is scheduled during school hours, students who wish to attend will need parental permission to be released from school.

Please do not hesitate to contact me or the school counselors with any questions or concerns.

Sincerely,[Principal]

Sample Media Statement

To be provided to local media outlets either upon request or proactively.

School personnel were informed by the coroner’s office that a [__]-year-old student at [________] school has died. The cause of death was suicide.

Our thoughts and support go out to [his/her] family and friends at this difficult time.

The school will be hosting a meeting for parents and others in the community at 2022. Members of the school’s Crisis Response Team [or mental health professionals] will be present to provide information about common reactions following a suicide and how adults can help youths cope. They will also provide information about suicide and mental illness in adolescents, including risk factors and warning signs of suicide, and will address attendees’ questions and concerns. A meeting announcement has been sent to parents, who can contact school administrators or counselors at [number] or [e-mail address] for more information.

Trained crisis counselors will be available to meet with students and staff starting tomorrow and continuing over the next few weeks as needed.

Suicide Warning Signs

These signs may mean someone is at risk for suicide. Risk is greater if a behavior is new or has recently increased in frequency or intensity, and if it seems related to a painful event, loss, or change.

  1. Talking about wanting to die or kill oneself
  2. Looking for ways to kill oneself, such as searching online or buying a gun
  3. Talking about feeling hopeless or having no reason to live
  4. Talking about feeling trapped or in unbearable pain
  5. Talking about being a burden to others
  6. Increasing the use of alcohol or drugs Acting anxious or agitated, or behaving recklessly
  7. Sleeping too little or too much
  8. Withdrawing or feeling isolated
  9. Showing rage or talking about seeking revenge
  10. Displaying extreme mood swings

Local Community Mental Health Resources

[To be inserted by school]

National Suicide Prevention Lifeline

800-273-TALK (8255)

[Local hotline numbers to be inserted by school]

Recommendations for Reporting on Suicide

Research has shown that graphic, sensationalized, or romanticized descriptions of suicide deaths in the news media can contribute to suicide contagion (“copycat” suicides), particularly among youth. 

Media Contact

NAME:

TITLE:

SCHOOL:

PHONE:

E-MAIL ADDRESS:

Key Messages for Media Spokesperson

For use when fielding media inquiries.

Suicide/Mental Illness

  1. Depression is the leading cause of suicide in teenagers. 
  2. About 6 percent of teenagers will develop depression yearly. Sadly, more than 80 percent of these kids will not have their illness properly diagnosed or treated, which can also lead to school absenteeism, failing grades, dropouts, crimes, and drug and alcohol abuse. 
  3. Depression is among the most treatable of all mood disorders. More than three fourths of people with depression respond positively to treatment. 
  4. The best way to prevent suicide is through early detection, diagnosis, and vigorous treatment of depression and other mental disorders, including addictions. 

School’s Response Messages

  1. We are heartbroken over the death of one of our students. Our hearts, thoughts, and prayers go out to [his/her] family and friends, and the entire community. 
  2. We will be offering grief counseling for students, faculty and sta starting on 2022 through 2022. 
  3. We will be hosting an informational meeting for parents and the community regarding suicide prevention on 2022. Experts will be on hand to answer questions. 
  4. No TV cameras or reporters will be allowed in the school or on school grounds. 

School Response to Media

  1. Research has shown that graphic, sensationalized, or romanticized descriptions of suicide deaths in the news media can contribute to suicide contagion (“copycat” suicides), particularly among youth. 
  2. Media coverage that details the location and manner of suicide with photos or video increases risk of contagion. 
  3. Media should also avoid oversimplifying cause of suicide (e.g., “student took his own life after breakup with girlfriend”). is gives the audience a simplistic understanding of a very complicated issue. 
  4. Instead, remind the public that more than 90 percent of people who die by suicide have an underlying mental disorder such as depression. 
  5. Media should include links to or information about helpful resources such as local crisis hotlines or the National Suicide Prevention Lifeline 800-273-TALK (8255). 

Sample Agenda for Parent Meeting

Meetings with parents can provide a helpful forum for disseminating information and answering questions. The Crisis Response Team Leader, Team Coordinator, all Crisis Response Team members, the superintendent, and the school principal should attend. Representatives from community resources such as mental health providers, county crisis services, and clergy may also be invited to be present and provide materials. This is a good time to acknowledge that suicide can be a di cult subject to talk about and to distribute the handout on Talking About Suicide.

A word of caution: Large, open-microphone meetings are not advised, since they can result in an unwieldy, unproductive session focused on scapegoating and blaming. Instead, the meeting should ideally be broken into two parts. During the first part, presented by school staff, the focus should be on dissemination of general information to parents, without opening the meeting to discussion. During the second part, have parents meet in small groups with trained crisis counselors for questions and discussion. The following is a sample meeting agenda.

First Part: General Information (45 to 50 minutes)

Crisis Response Team Leader or School Superintendent

  1. Welcomes all and expresses sympathy 
  2. Introduces the principal and members of the Crisis Response Team 
  3. Expresses confidence in the staff’s ability to assist the students 
  4. Encourages parent and school collaboration during this di cult time 
  5. Reassures attendees that there will be an opportunity for questions and discussion 
  6. States school’s goal of treating this death as it would any other death, regardless of cause, while remaining aware that adolescents can be vulnerable to risk of imitative suicidal behavior 
  7. States importance of balancing need to grieve with not inadvertently oversimplifying, glamorizing, or romanticizing suicide 

Principal

  1. Outlines the purpose and structure of the meeting
  2. Verifies the death (see Sample Notification Announcements for Parents)
  3. Discourages the spread of rumors
  4. Informs parents about the school’s response activities including media requests
  5. Informs parents about student release policy for funerals 

Crisis Response Team Leader (or other appropriate Crisis Team member)

  1. Discusses how school will help students cope.
  2. Mentions that more information about bereavement after suicide is available at (place to get more information).
  3. Shares handout Facts about Suicide and Mental Disorders in Adolescents emphasizing risk factors and warning signs and noting that over 90 percent of suicides are linked to underlying mental disorders such as depression or anxiety that can cause substantial psychological pain but may not have been apparent to others (or that may have shown up as behavior problems or substance abuse).
  4. Reminds parents that help is available for any student who may be struggling with mental health issues or suicidal feelings. 
  5. Provides contact information (names, telephone numbers, and e-mail addresses) for mental health resources at school and in the community, such as:
  6. school counselors
  7. community mental health agencies 
  8. emergency psychiatric screening centers
  9. children’s mobile response programs
  10. National Suicide Prevention Lifeline 1-800-273-TALK (8255) 

Second Part: Small Group Meetings (1 hour)

  1. Ideally, there should be no more than 8 to 10 parents per group. 
  2. Each group should be facilitated by at least two trained counselors. 
  3. Support sta should be available to direct parents to meeting rooms, distribute handouts, and make water and tissues available. 
  4. If possible, additional counselors should be available to meet with parents individually as needed. 

Some Additional Considerations

  1. Since some parents may arrive with young children, provide onsite childcare.
  2. Provide separate discussion groups for students who may accompany parents. 
  3. Media should not be permitted access to the small groups; arrange for the media spokesperson to meet with any media. 
  4. In some cases (for example, when the death has received a great deal of sensationalized media attention), it may be necessary to arrange for security to assist with the flow of media and crowd control. 

Facts About Suicide and Mental Disorders in Adolescents

Suicide is not inexplicable and is not simply the result of stress or difficult life circumstances. A key suicide risk factor is an undiagnosed, untreated, or ineffectively treated mental disorder. Research shows that over 90 percent of people who die by suicide have a mental disorder at the time of their death.

In teens, the mental disorders most closely linked to suicide risk are major depressive disorder, bipolar disorder, generalized anxiety disorder, conduct disorder, substance use disorder, and eating disorders. While in some cases these disorders may be precipitated by environmental stressors, they can also occur as a result of changes in brain chemistry, even in the absence of an identifiable or obvious “reason.”

Suicide is almost always complicated. In addition to the underlying disorders listed above, suicide risk can be affected by personality factors such as impulsivity, aggression, and hopelessness. Moreover, suicide risk can also be exacerbated by stressful life circumstances such as a history of childhood physical and/or sexual abuse; death, divorce, or other trauma in the family; persistent serious family conflict; traumatic breakups of romantic relationships; trouble with the law; school failures and other major disappointments; and bullying, harassment, or victimization by peers.

It is important to remember that the vast majority of teens who experience even very stressful life events do not become suicidal. In some cases, such experiences can be a catalyst for suicidal behavior in teens who are already struggling with depression or other mental health problems. In others, traumatic experiences (such as prolonged bullying) can precipitate depression, anxiety, abuse of alcohol or drugs, or another mental disorder, which can increase suicide risk. Conversely, existing mental disorders may also lead to stressful life experiences such as family conflict, social isolation, relationship breakups, or school failures, which may exacerbate the underlying illness and in turn increase suicide risk.

Warning Signs of Suicide

These signs may mean someone is at risk for suicide. Risk is greater if a behavior is new or has recently increased in frequency or intensity, and if it seems related to a painful event, loss, or change.

  • Talking about wanting to die or kill oneself
  • Looking for ways to kill oneself, such as searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious or agitated, or behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

What to Do in a Crisis

Take any threat or talk about suicide seriously. Start by telling the person that you are concerned. Don’t be afraid to ask whether she or he is considering suicide or has a plan or method in mind. Resist the temptation to argue the person out of suicide by saying, “You have so much to live for” or “Your suicide will hurt your family and friends.” Instead, seek professional help.

In an acute crisis:

  1. Call 911.
  2. Do not leave the person alone.
  3. If safe to do so, remove any rearms, alcohol, drugs, or sharp objects that could be used.
  4. Call the National Suicide Prevention Lifeline: 1-800-273-TALK (8255).
  5. Take the person to an emergency room or walk-in clinic at a psychiatric hospital.

Symptoms of Mental Disorders Associated with Suicide Risk

Most adults are not trained to recognize signs of serious mental disorders in teens, and symptoms are therefore often misinterpreted or attributed to normal adolescent mood swings, laziness, poor attitude, or immaturity. Diagnosis of a mental disorder should always be made by a qualified mental health professional.

The key symptoms of major depressive disorder in teens are sad, depressed, angry, or irritable mood and lack of interest or pleasure in activities the teen used to enjoy, lasting at least two weeks. Symptoms represent a clear change from the person’s normal behavior and may include changes in appetite or sleep, feelings of worthlessness/guilt, inability to concentrate, slowed or agitated movement, recurrent thoughts of death or suicide, fatigue/loss of energy, and self-harm behavior.

Sometimes referred to as manic depression, bipolar disorder includes alternating episodes of depression and mania. Symptoms of mania last at least one week, cause clear social or academic problems, and include extreme distractibility, lack of need for sleep, unusually rapid speech or motor activity, excessive talking, and involvement in risky activities such as gambling or irresponsible sexual behavior.

The key characteristic of generalized anxiety disorder is excessive, uncontrolled worry (for example, persistent worry about tests or speaking in class) occurring on most days for a period of six months. Symptoms may include restlessness or feeling keyed up, irritability, being easily fatigued, muscle tension, difficulty concentrating, and sleep disturbances.

Teens with substance use disorder show a problematic pattern of drug or alcohol use over 12 months or more, leading to signify cant impairment or distress. Symptoms include taking larger amounts, over a longer period, than intended; continued use despite knowing that it is causing problems; increased irritability and anger; sleep disturbances; and family conflict over substance use.

Conduct disorder is a repetitive, persistent pattern in children or adolescents of violating the rights of others, rules, or social norms, occurring over 12 months. Symptoms include bullying or threatening others, physical fights, re-setting, destroying property, breaking into houses/cars, physical cruelty to people or animals, lying, shoplifting, running away from home, and frequent truancy.

Anorexia nervosa and bulimia are eating disorders that are strongly linked to other mental disorders, especially depression and anxiety. Symptoms of anorexia nervosa include refusal to maintain body weight at a minimally normal level for age and height, intense fear of gaining weight, and a denial of low body weight. Symptoms of bulimia include repeated episodes of binge eating (at least twice a week for three months) combined with recurrent inappropriate behaviors to avoid gaining weight such as vomiting, misuse of laxatives, or excessive exercise.

Help Is Available

If there are concerns about a student’s emotional or mental health, a referral should be made to an appropriate mental health professional for assessment, diagnosis, and possible treatment. Mental health resources that may be available include school counselors, community mental health agencies, emergency psychiatric screening centers, and children’s mobile response programs. Pediatricians and primary care providers can also be a source of mental health referrals.

Some depressed teens show improvement in just four to six weeks with talk therapy alone. Most others experience a significant reduction of depressive symptoms with antidepressant medication. Medication is usually essential in treating severe depression and other serious mental disorders, such as bipolar disorder and schizophrenia. Since 2004, an FDA warning has recommended close monitoring of youth taking antidepressants for worsening of symptoms, suicidal thoughts or behavior, and other changes. Risks of medication must be weighed against the risks of not effectively treating depression or other serious mental disorders.

Helping Students Cope

In the aftermath of a suicide, students and others in the school community may—not surprisingly—feel emotionally overwhelmed, which can disrupt the school’s ability to return to its primary function of educating students, and can increase the risk of prolonged stress responses and even suicide contagion. The following are strategies that schools can use to help students balance the timing and intensity of their emotional expression and restore the school’s ability to function effectively.

Key Considerations

 The term emotional regulation refers to a person’s ability to appropriately experience and express intense emotions such as grief and fear. Most adolescents have mastered basic skills that allow them to handle strong emotions encountered day to day. But these skills may be challenged in the face of a suicide. In addition, young people may not yet have learned how to recognize complex feelings or physical indicators of distress, such as stomach upset, restlessness, or insomnia. Moreover, adolescence marks a time of increased risk for diffculties with emotional regulation, given the intensification of emotional responses that come with puberty and the structural changes in the brain that occur during this developmental period.

It is therefore important for schools to provide students with appropriate opportunities to express their emotions and identify strategies for managing them, so the school can continue its primary focus of education. It may also be useful for school staff to identify and reach out to families of students who are not coming to school.

When implementing these strategies, leadership will most likely be provided by the school counselor, school nurse, and/or community mental health partner, all of whom should be members of the school’s Crisis Response Team. However, all adults in the school community can help by modeling calm, caring, and thoughtful behavior.

Schedule Meetings with Students in Small Groups

It will likely be necessary to adjust the regular academic schedule in order to spend time with students to help address their emotional needs. It is preferable to reach out to students in a deliberate and timely way rather than to allow the emotional environment to escalate. It is also preferable to meet with students in small groups, which enables adults to identify those youth who appear in need of additional attention.

If possible, have counselors go into the classrooms to give students accurate information about suicide, the kinds of reactions that can be expected after hearing about a peer’s suicide death, and safe coping strategies to help them in the coming days and weeks.

Wherever possible, group meetings should follow a structured outline, keep to a time limit,
and provide each student with an opportunity to speak. e meetings should focus on helping students identify and express their feelings and discuss practical coping strategies (including appropriate ways to memorialize the loss) so they may return their focus to their regular routines and activities.

If the deceased student participated in sports, clubs, or other school activities, the first practice, game, rehearsal, or meeting after the death may be di cult for the other students. These events can provide further opportunities for the adults in the school community to help the students appropriately acknowledge the loss.

Help Students Identify and Express Their Emotions

Youth will vary widely in terms of emotional expression. Some may become openly emotional, others may be reluctant to talk at all, and still others may use humor. Acknowledge the breadth of feelings and diversity of experiences and emphasize the importance of being respectful
of others.

Some students may need help to identify emotions beyond simply sad, angry, or happy, and may need reassurance that a wide range of feelings and experiences are to be expected. They may also need to be reminded that emotions may be experienced as physical symptoms, including butterflies in the stomach, shortness of breath, insomnia, fatigue, or irritability. To facilitate this discussion, students may be asked:

What is your biggest concern about the immediate future? What would help you feel safer right now?

Practical Coping Strategies

Encourage students to think about specific things they can do when intense emotions such as worry or sadness begin to well up, including:

  1. simple relaxation and distraction skills, such as taking three deep slow breaths, counting to 10, or picturing themselves in a favorite calm and relaxing place 
  2. engaging in favorite activities or hobbies such as music, talking with a friend, reading, or going to a movie 
  3. exercising 
  4. thinking about how they’ve coped with difficulties in the past and reminding themselves that they can use those same coping skills now 
  5. writing a list of people they can turn to for support 
  6. writing a list of things they’re looking forward to 
  7. focusing on individual goals, such as returning to a shared class or spending time with mutual friends 

Often, youth will express guilt about having fun or thinking about other things. They may feel that they somehow need permission to engage in activities that will help them feel better and take their mind o the stressful situation. 

Students should also be encouraged to think about how they want to remember their friend. Ideas range from writing a personal note to the family, to attending the memorial service, to doing something kind for another person in honor of their friend. Be sure to educate students about the school’s guidelines regarding memorialization. Acknowledging their need to express their feelings while helping them identify appropriate ways to do so can begin the process of returning their focus to their daily lives and responsibilities. 


Reach Out to Parents

Parents may need guidance on Talking About Suicide with their children and how best to support them at this difficult time. They may also need reliable information relating to the document Facts About Mental Disorders and Suicide in Adolescents.

Anniversary of the Death

The anniversary of the death (and other significant dates, such as the deceased’s birthday) may stir up emotions and can be an upsetting time for some students and staff . It is helpful to anticipate this and provide an opportunity to acknowledge the date, particularly with those students who were especially close to the student who died.

Working with the Community

Because schools exist within the context of a larger community, it’s very important that in the aftermath of a suicide or other death they establish and maintain open lines of communication with community partners such as the coroner/medical examiner, police department, mayor’s office, funeral director, clergy, and mental health professionals.

Key Considerations

The school is in a unique position to encourage open and constructive dialogue among important community partners, as well as with the family.

Even in those realms where the school may have limited authority (such as the funeral), a collaborative approach allows for the sharing of important information and coordination of strategies. For example, a school may be able to offer relevant information (such as the likely turnout at the funeral) and anticipate problems (such as the possibility that students may gather late at night at the place where the deceased died). A coordinated approach can be especially critical when the suicide death receives a great deal of media coverage and the entire community becomes involved.

Coroner / Medical Examiner

The coroner or medical examiner is the best starting point for confirming that the death has in fact been declared a suicide. (In some cases, it may also be necessary to contact the police department to verify the information). It is important that schools Get the Facts First and ascertain that all information is accurate before communicating with students.

However, given how quickly news and rumors spread (including through media coverage, e-mail, texting, and social networking sites), schools may not be able to wait for a final determination before they need to begin communicating with the students. In those cases, schools can say, “At this time, this is what we know…”

There may also be cases in which there is disagreement between the authorities and the family regarding the cause of death. For example, the death may have been declared a probable suicide but the family believes it to have been a homicide or an accident. Or the death may have been declared a suicide, but the family does not want this communicated, perhaps due to stigma, for fear of risking contagion, or because they simply do not (yet) believe or accept that it was suicide.

Schools have a responsibility to balance the need to be truthful with the school community while remaining sensitive to the family. They can take this opportunity to educate the community (including potentially vulnerable students) about the causes and complexity of suicide and to identify available mental health resources. For example, a school might say, “According to the medical examiner, the death has been declared a suicide. It can sometimes be di cult for us to be absolutely sure whether a death was intentional or not (for example, in the case of a drug overdose or a motor vehicle accident involving a single vehicle). While we may never know all of the details, we are deeply saddened, and want to take this opportunity to teach you some important information about suicide and where you can find help.”

Of course, if a legal gag order is in effect, the school attorney should first research the applicable state law regarding discussing the cause of death before the school issues a statement.

Police Department

The police will likely be an important source of information about the death, particularly if there is an ongoing investigation (for example, if it has not yet been determined whether the death was suicide or homicide). e school will need to be in close communication with the police to determine (a) what they can and cannot say to the school community so as not to interfere with the investigation, and (b) whether there are certain students who must be interviewed by the police before the school can debrief or counsel them in any way.

There may also be situations in which the school has information that’s relevant to the ability of the police to keep students safe. For example, the school may become aware that students have established a memorial on campus and may even be engaging in dangerous behavior (such as gathering in large groups at the site of the death at night or holding vigils at which alcohol is being consumed) and may need to enlist the cooperation of the police to keep the students safe. e school may also be in a unique position to brief the police (and even the family) about what to expect at the funeral or memorial service in terms of turnout and other safety concerns.

Mayor’s Office and Local Government

A student suicide death may reveal an underlying community-wide problem such as drug or alcohol use, bullying, gang violence, or a possible community-wide suicide cluster. Because schools function within—not separate from—the surrounding community, local government entities such as the mayor’s o ce can be helpful partners in promoting dialogue and presenting a united front in the interest of protecting the community’s young people.

Funeral Director

The school and funeral home are complementary sources of information for the community. Schools are often in an excellent position to give the funeral director a heads-up about what to expect at the funeral in terms of the number and types of students likely to attend, and the possible need to have additional security present. e school can also provide information about local counseling and other resources to the funeral directors, with the request that the information be made available to attendees at the funeral.

Schools can ask the funeral director to provide (or recommend) materials that the school could provide to students to help them prepare for the funeral. Schools can also encourage the funeral director to talk to the family about the importance of scheduling the service outside of school hours, encouraging students’ parents to attend, and providing counselors to meet with distraught students after the service (and the need for a quiet area in which to do so).

Clergy

Because the school may be in the best position to understand the risk of contagion, it can play an important role by encouraging a dialogue between the family and the clergy (or whomever will be officiating at the service) to help sensitize them to the issue. This dialogue may provide an opportunity to explain the importance of not inadvertently romanticizing either the student or the death in the eulogy, but instead emphasizing the connection between suicide and underlying mental health issues such as depression or anxiety, which can cause substantial psychological pain but may not be apparent to others (or may manifest as behavioral problems or substance abuse).

Of course, if the school has a religious affiliation, it will be important to include clergy who are on staff in any communications and outreach e orts to support the student body, and encourage them to be familiar with their faith’s current understanding of the relationship between mental illness and suicide.

Mental Health and Medical Communities

 

Most schools have counselors on staff , and it is important that these individuals are linked to other mental health professionals in the community. In particular, it is advisable that the school establish an ongoing relationship with a community mental health center that can see students in the event of a psychiatric emergency. In the aftermath of a suicide death, schools will want to notify the center to ensure seamless referrals if students show signs of distress. Schools will also want to publicize crisis hotline numbers such as Lifeline: 800-273-TALK (8255).

In addition, schools can encourage the local medical community, including primary care doctors and pediatricians, to screen for depression, substance abuse, and other relevant disorders in the youth they see.

Outside Trauma Responders

 

Working with schools in the aftermath of a suicide death can easily exhaust school crisis team members, which can interfere with their ability to effectively assist the students. Bringing in trained trauma responders from other school districts or local mental health or crisis centers to work alongside the school’s crisis team members—and to provide care for the caregivers—can be quite helpful.

 

Community Organizations

 

Schools may also wish to network with their local chapter of the American Foundation for Suicide Prevention and with suicide bereavement support groups.

Memorialization

School communities often wish to memorialize a student who has died, reflecting a basic human desire to remember those we have lost. It can be challenging for schools to strike a balance between compassionately meeting the needs of distraught students while preserving the ability of the school to fulfill its primary purpose of education. In the case of suicide, schools must consider how to appropriately memorialize the student who died without risking suicide contagion among other students who may themselves be at risk.

KEY CONSIDERATIONS

It is very important that schools strive to treat all deaths in the same way. Having one approach for memorializing a student who died of cancer or in a car accident and a different approach for a student who died by suicide reinforces stigma and may be deeply and unfairly painful to the student’s family and friends.

Nevertheless, because adolescents are especially vulnerable to the risk of suicide contagion, it’s equally important to memorialize the student in a way that doesn’t inadvertently glamorize or romanticize either the student or the death. Schools can do this by seeking opportunities
to emphasize the connection between suicide and underlying mental health issues such as depression or anxiety that can cause substantial psychological pain but may not be apparent to others (or that may manifest as behavioral problems or substance abuse).

Wherever possible, schools should both meet with the student’s friends and coordinate with the family, in the interest of identifying a meaningful, safe approach to acknowledging the loss. is section includes several creative suggestions for memorializing students who have died by suicide.

Funerals and Memorial Services

 

All the recommendations made here focus on keeping the regular school schedule intact to the maximum extent possible for the benefit of the entire student body (including those who may not have known the deceased).

While at first glance schools may appear to provide an obvious setting for a funeral or memorial service because of their connection to the community and their ability to accommodate a large crowd, it is strongly advised that such services not be held on school grounds, to enable the school to focus instead on maintaining its regular schedule, structure, and routine. Additionally, using a room in the school for a funeral service can inextricably connect that space to the death, making it di cult for students to return there for regular classes or activities.

In situations where school personnel are able to collaborate with the family regarding the funeral or memorial service arrangements, it is also strongly advised that the service be held outside of school hours.

If the family does hold the service during school hours, it is recommended that school remain open and that school buses not be used to transport students to and from the service. Students should be permitted to leave school to attend the service only with appropriate parental permission (regular school protocols should be followed for dismissing students over the age of majority).

If possible, the school should coordinate with the family and funeral director to arrange for counselors to attend the service. A guide for funeral directors is available at http://www.sprc.org/library/funeraldirectors.pdf. In all cases, the principal or another senior administrator should attend the funeral.

Schools should strongly encourage parents whose children express an interest in attending the funeral to attend with them. is provides not only emotional support but also an opportunity for parents to open a discussion with their children and remind them that help is available if they or a friend are in need.

Spontaneous Memorials

 

In the immediate aftermath of a suicide death, it is not unusual for students to create a spontaneous memorial by leaving owers, cards, poems, pictures, stu ed animals, or other items in a place closely associated with the student, such as his or her locker or classroom seat, or at the site where the student died. Students may even come to school wearing t-shirts or buttons bearing photographs of the deceased student.

The school’s goal should be to balance the students’ need to grieve with the goal of limiting the risk of inadvertently glamorizing the death. In all cases, schools should have a consistent policy so that suicide deaths are handled in the same manner as any other deaths. A combination
of time limits and straightforward communication can help to restore equilibrium and avoid glamorizing the death in ways that may increase the risk of contagion. Although it may in some cases be necessary to set limits for students, it is important to do so with compassion and sensitivity, offering creative suggestions whenever possible. For example, schools may wish

to make posterboard and markers available so that students can gather and write messages. It
is advisable to set up the posters in an area that may be avoided by those who don’t wish to participate (i.e., not in the cafeteria or at the front entrance). After a few days, the posters can be removed and offered to the family.

When a memorial is spontaneously created on school grounds, schools are advised to monitor it for messages that may be inappropriate (hostile or in inflammatory) or that indicate students who may themselves be at risk. Schools can leave such memorials in place until after the funeral (or for up to approximately five days), after which the tribute objects may be offered to the family. It is generally not necessary to prohibit access to the site or to cordon it off, which would merely draw excessive attention to it.

It is recommended that schools discourage requests to create and distribute t-shirts and buttons bearing images of the deceased by explaining that, while these items may be comforting to some students, they may be quite upsetting to others. If students come to school wearing such items without first seeking permission, it is recommended that they be allowed to wear the items for that day only, and that it should be explained to them that repeatedly bringing images of the deceased student into the school can be disruptive and can glamorize suicide.

Since the emptiness of the deceased student’s chair can be unsettling and evocative, after approximately five days (or after the funeral), seat assignments may be re-arranged to create a new environment. Teachers should explain in advance that the intention is to strike a balance between compassionately honoring the student who has died while at the same time returning the focus back to the classroom curriculum. The students can be involved in planning how to respectfully remove the desk; for example, they could read a statement that emphasizes their love for their friend and their commitment to work to eradicate suicide in his or her memory.

When a spontaneous memorial occurs o school grounds, the school’s ability to exert in influence is limited. It can, nevertheless, encourage a responsible approach among the students by explaining that it is recommended that memorials be time-limited (again, approximately five days, or until after the funeral), at which point the memorial would be disassembled and the items offered to the family. Another approach is to suggest that the students participate in a (supervised) ceremony to disassemble the memorial, during which music could be played and students could be permitted to take part of it home; the rest of the items would then be offered to the family.

Students may also hold spontaneous gatherings or candlelight vigils. Schools should discourage gatherings that are large and unsupervised; when necessary, administrators may consider enlisting the cooperation of local police to monitor o -campus sites for safety. Counselors can also be enlisted to attend these gatherings to offer support, guidance, and supervision.

It is not recommended that flags be own at half-staff (a decision generally made by local government authorities rather than the school administration in any event).

 

School Newspapers

Coverage of the student’s death in the school newspaper may be seen as a kind of memorial; also, articles can be used to educate students about suicide warning signs and available resources. It is strongly recommended that any such coverage be reviewed by an adult to ensure that it conforms to the standards set forth in Reporting on Suicide: Recommendations for the Media, which was created by the nation’s leading suicide prevention organizations.

 

Events

 

The student’s classmates may wish to dedicate an event (such as a dance performance, poetry reading, or sporting event) to the memory of their friend. End-of-the-year activities may raise questions of whether to award a posthumous degree or prize, or include a video tribute to the deceased student during graduation. e guiding principle is that all deaths should be treated the same way. Schools may also wish to encourage the student’s friends to consider creative suggestions, such as organizing a suicide prevention-awareness or fundraising event.

Often, the parents of the deceased student express an interest in holding an assembly or other event to address the student body and describe the intense pain the suicide death has caused
to their family in the hopes that this will dissuade other students from taking their own lives. While it is surely understandable that bereaved parents would wish to prevent another suicide death, schools are strongly advised to explain that this is not an effective approach to suicide prevention and may in fact even be risky, because students who are suffering from depression or other mental health issues may hear the messaging very differently from the way it is intended, and may even become more likely to act on their suicidal thoughts. Instead, parents should be encouraged to work with the school to bring an appropriate educational program to the school, such as More an Sad: Teen Depression, a DVD that educates teens about the signs and symptoms of depression (available at http://www.morethansad.org) or others that are listed in the Suicide Prevention Resource Center/American Foundation for Suicide Prevention Best Practices Registry (available at http://www.sprc.org).

Yearbooks

 

Again, the guiding principle is that all deaths should be treated the same way. So if there is a history of dedicating the yearbook (or a page of the yearbook) to students who have died, that policy is equally applicable to a student who has died by suicide, provided that final editorial decisions are made by an adult.

Whenever possible, the focus should be on mental health and/or suicide prevention. For example, underneath the student’s picture it might say, “In your memory we will work to erase the stigma surrounding mental illness and suicide.” e page might also include pictures of classmates engaging in a suicide prevention event such as an Out of the Darkness community walk (http://www.outofthedarkness.org).

 

Graduation

If there is a tradition of including a tribute to deceased students who would have graduated with the class, students who have died by suicide should likewise be included. For example, schools may wish to include a brief statement acknowledging and naming those students from the graduating class who have died. Final decisions about what to include in such tributes should be made by an adult.

 

Permanent Memorials and Scholarships

Some communities wish to establish a permanent memorial (sometimes physical, such as planting a tree or installing a bench or plaque; sometimes commemorative, such as a scholarship). Others are afraid to do so.

While there is no research to suggest that permanent memorials per se create a risk of contagion, they can prove to be upsetting reminders to bereaved students, and therefore disruptive to
the school’s goal of maintaining emotional regulation. Whenever possible, therefore, it is recommended that they be established o school grounds. Moreover, the school should bear in mind that once it plants a tree, puts up a plaque, installs a park bench, or establishes a named scholarship for one deceased student, it should be prepared to do so for others, which can become quite di cult to sustain over time.

Creative Suggestions

 

Some schools may resist allowing any kind of memorialization at all, clamping down on any student desire to publicly acknowledge the death for fear of glamorizing suicide and risking suicide contagion. But simply prohibiting any and all memorialization is problematic in its
own right—it is deeply stigmatizing to the student’s family and friends, and can generate intense negative reactions, which can exacerbate an already di cult situation and undermine the school’s e orts to protect the student body’s emotional regulation.

Schools can play an important role in channeling the energy and passion of the students (and greater community) in a positive direction, balancing the community’s need to grieve with the impact that the proposed activity will likely have on students, particularly those who were closest to the student who died.

It can be helpful for schools to proactively suggest a meeting with the student’s close friends
to talk about the type and timing of any memorialization. This can provide an important opportunity for the students to be heard and for the school to sensitively explain its rationale for permitting certain kinds of activities and not others. Schools may even wish to establish a standing committee composed of students, school administrators, and family members that can be convened on an as-needed basis.

It can also be helpful for schools to come equipped with specific, constructive suggestions for safe memorialization, such as:

  • holding a day of community service or creating a school-based community service program in honor of the deceased 

  • putting together a team to participate in an awareness or fundraising event sponsored by
one of the national mental health or suicide prevention organizations (e.g., http://www. outofthedarkness.org), or holding a local fundraising event to support a local crisis hotline or other suicide prevention program 

  • sponsoring a mental health awareness day 

  • purchasing books on mental health for the school or local library 

  • working with the administration to develop and implement a curriculum focused on effective 
problem-solving 

  • volunteering at a community crisis hotline 

  • raising funds to help the family defray their funeral expenses
 making a book available in the school office for several weeks in which students can write 
messages to the family, share memories of the deceased, or offer condolences; the book can then be presented to the family on behalf of the school community 


Social Media

 

The term social media refers to the various Internet and mobile communications tools (such as texting, Facebook, Twitter, YouTube, MySpace and others) that may be used to communicate information extremely rapidly, often to large numbers of people. In the emotionally charged atmosphere that can follow a suicide death, schools may be inclined to try to control or stifle such communications by students—a task that is virtually impossible in any event, since they generally take place outside of school hours and property. Schools can, however, utilize social media effectively to disseminate information and promote suicide prevention efforts.

Key Considerations

 

Following a suicide death, students may immediately turn to social media for a variety of purposes, including transmitting news about the death (both accurate and rumored), calling for impromptu gatherings (both safe and unsafe), creating online memorials (both moving and risky), and posting messages (both appropriate and hostile) about the deceased.

Although schools may initially consider social media to be outside of its traditional jurisdiction, they can in fact collaborate with students and utilize these tools to disseminate important
and accurate information to the school community, identify students who may be in need of additional support or further intervention, share resources for grief support and mental health care, and promote safe messages that emphasize suicide prevention and minimize the risk of suicide contagion.

Involve Students

 

It can be very beneficial for a designated member of the Crisis Response Team (ideally someone from the school’s information technology department) to reach out to friends of the deceased and other key students to work collaboratively in this area. Working in partnership with student leaders will enhance the credibility and effectiveness of social media e orts, since the students themselves are in the best position to help identify the particular media favored by the student body, engage their peers in honoring their friend’s life appropriately and safely, and inform school staff about online communications that may be worrisome.

Students who are recruited to help should be reassured that school staff are only interested in supporting a healthy response to their peer’s death, not in thwarting communication. They should also be made aware that staff are available and prepared to intervene if any communications reveal cause for concern.

Disseminate Information

 

Schools may already have a website and/or an online presence (or page) on one or more social media sites; students can help identify others that are currently popular. These can be used to proactively communicate with students, teachers, and parents about:


  • the funeral or memorial service (schools should of course check with the student’s family before
  • sharing information about the funeral)
 where students can go for help or meet with counselors
  • mental illness and the causes of suicide 

  • local mental health resources 

  • the National Suicide Prevention Lifeline number: 800-273-TALK (8255) 

  • national suicide prevention organizations such as the National Suicide Prevention Lifeline 
(http://www.suicidepreventionlifeline.org), the American Foundation for Suicide Prevention (http://www.afsp.org), and the Suicide Prevention Resource Center (http://www.sprc.org). 


Schools should emphasize help-seeking and suicide prevention. More specific guidance for safe message content may be found at:

http://www.sprc.org/library/SafeMessaging nal.pdf. Students can also be enlisted to post this information on their own online pages. 


Online Memorial Pages

Online memorial pages and message boards have become common practice in the aftermath of a death. 
Some schools (with the permission and support of the deceased student’s family) may choose
to establish a memorial page on the school website or on a social networking site. As with all memorialization following a suicide death, such pages should take care not to glamorize the death in ways that may lead other at-risk students to identify with the person who died. It is therefore vital that memorial pages utilize safe messaging, include resources, be monitored by an adult, and be time-limited. 


It is recommended that online memorial pages remain active for up to 30 to 60 days after the death, at which time they should be taken down and replaced with a statement acknowledging the caring and supportive messages that had been posted and encouraging students who wish to further honor their friend to consider other creative suggestions. 


If the student’s friends create a memorial page of their own, it is important that school personnel communicate with the students to ensure that the page includes safe messaging and accurate information. School personnel should also join any student-initiated memorial pages so that they can monitor and respond as appropriate. 


Monitor and Respond

To the extent possible, social media sites (including the deceased’s wall or personal pro le pages) should be monitored for:


  • rumors

  • information about upcoming or impromptu gatherings 

  • derogatory messages about the deceased

  • messages that bully or victimize current students

  • comments indicating students who may themselves be at risk 


Responses may include posting comments that dispel rumors, reinforce the connection between mental illness and suicide, and o er resources for mental health care. In some cases, the appropriate response may go beyond simply posting a comment, safe message, or resource information. It may extend to notifying parents and local law enforcement about the need for security at a late-night student gathering, for example. 


In some cases it may be necessary to take action against so-called trolls who may seek out memorial pages on social media sites and post deliberately offensive messages and pictures. Most sites have a report mechanism or comparable feature, which enables users to notify the site of the offensive material and request that it be removed. The administrator of the memorial page may also be able to block particular individuals from accessing the site. Because the available options vary from site to site and can evolve over time, schools are advised to contact the particular site for instructions.

The National Suicide Prevention Lifeline has developed an in-depth online postvention manual that details how to find various social media sites and other online groups, post resources, and reach out to parents. It also includes case examples and resource links and is available at:

http://www.sprc.org/library/LifelineOnlinePostventionManual.pdf.

On occasion, schools may become aware of posted messages indicating that another student may be at risk of suicide. Messages of greatest concern may suggest hopelessness or refer to plans to join the deceased student. In those instances, it may be necessary to alert the student’s family and/or contact the National Suicide Prevention Lifeline to request that a crisis center follow up with the student.

Suicide Contagion

While it is outside the scope of this toolkit to fully explore the phenomenon of imitative suicidal behavior (see Additional Information), what follows are general guidelines for school communities facing possible contagion.

Key Considerations

Contagion is the process by which one suicide death may contribute to another. In fact, suicide(s) can even follow the death of a student from other causes, such as an accident. Although contagion is comparatively rare (accounting for between 1 percent and 5 percent of all suicide deaths annually), adolescents and teenagers appear to be more susceptible to imitative suicide than adults, largely because they may identify more readily with the behavior and qualities of their peers.

If there appears to be contagion, schools should consider taking additional steps beyond the basic crisis response outlined in this toolkit, including identifying other students who may be at heightened risk of suicide and actively collaborating with community partners in a coordinated suicide prevention effort.

Identifying Other Students at Possible Risk for Suicide

 

In the face of apparent contagion, it is important for schools to utilize counselors and others who have been trained to identify students who may be at heightened risk for suicide due
to underlying mental disorders or behavioral problems (such as depression, anxiety, conduct disorder, and/or substance abuse) and who have been exposed to the prior suicide either directly (by virtue of close identification or relationship with the deceased) or indirectly (by virtue of extensive media coverage).

Of special concern are those students who:

  • have a history of suicide attempts 

  • are dealing with stressful life events such as a death or divorce in the family 

  • were eyewitnesses to the death 

  • are family members or close friends of the deceased (including siblings at other schools as well 
as teammates, classmates, and acquaintances of the deceased) 

  • received a phone call, text, or other communication from the deceased foretelling the suicide 

  • may have fought with or bullied the deceased 
Schools can also seek to identify those in the general student body who may be at heightened risk by using a mental health screening tool (a process sometimes called case finding) such as TeenScreen

Schools and Communities of the National Center for Mental Health Checkups (http://www.teenscreen.org),

Signs of Suicide (http://www.mentalhealthscreening.org), or others listed in the

Suicide Prevention Resource Center/American Foundation for Suicide Prevention

Best Practices Registry (http://www.sprc.org). 


Connecting with Local Mental Health Resources

 

Schools should work with local primary care and mental health resources (including pediatricians, community mental health centers, and local private practice mental health clinicians) to develop plans to refer at-risk youth. Once plans are established, they should be reviewed with school counselors and other personnel so that any student who is identified as being at high risk can be referred to a local mental health screening center or private practitioner for further evaluation.

Managing Heightened Emotional Reactions at School

 

The possibility of a suicide cluster can be exceedingly upsetting. At a minimum, school counselors and/or trained outside professionals should be available to meet with distraught students for grief counseling and to help them make linkages with other resources in the community.

Schools, in partnership with community mental health resources, might also consider creating drop-in centers that provide a safe place for youth to be together after school hours. These
can be staffed by volunteer counselors and clinicians from the community who can provide grief counseling as well as identify and refer youth who may need additional mental health or substance abuse services. These centers can also be used during times of particularly heightened emotion such as graduation or the anniversary of the death(s).

Monitoring Media Coverage

Particularly when there have been multiple suicides, media interest in the deaths will be intense. e school should delegate one spokesman for public statements, disseminate the document Reporting on Suicide: Recommendations for the Media, and follow the safe messaging guidelines at:

http://www.sprc.org/library/SafeMessaging nal.pdf.

The risk of contagion is related to the amount, duration, and prominence—as well as the content—of media coverage, so it is extremely important that schools strongly encourage the media to adhere to the parameters set forth by the nation’s leading suicide prevention organizations. These recommendations include:

  • not glamorizing or romanticizing the victim or suicide itself 

  • not oversimplifying the causes of suicide 

  • not detailing the method 

  • not including photographs of the death scene or of devastated mourners, which can be 
attractive for vulnerable youth who may be desperate for attention and recognition 

  • including hotline numbers (such as Lifeline: 800-273-8255) and information about local 
mental health resources in each article

 

Building a Community Coalition

 


Schools cannot possibly manage all aspects of reacting to possible contagion and preventing its spread without collaborating with community partners. It is strongly recommended that the community convene a coordinating committee that can meet on a regular basis and serve as a decision- making body and identify a leader for these efforts. The committee should include senior 
 representation from the school, together with representatives from as many of the following
as possible:


  • law enforcement

  • government, such as the mayor’s office, medical examiner’s office, and public health department
  • parents who have demonstrated community leadership in addressing drug and alcohol abuse,
  • bullying, or other related issues
  • mental health community, such as community mental health centers, psychiatric screening centers, private practitioners, and substance abuse treatment centers
  • social service agencies
  • clergy
  • funeral directors
  • First responders and hospital emergency room personnel
  • media (as coalition members, not to cover it as a news event)
  • students
  • suicide bereavement support group facilitators
  • primary health care providers/clinics

The committee’s initial goals should include:

  • Identifying a leader or lead agency 

  • Identifying any particular risk factors within the community, such as widespread drug and 
alcohol use, bullying, or easy access to means of suicide 

  • Mobilizing existing mental health and primary care resources to identify and help young 
people who may be at high risk 

  • Mobilizing law enforcement to patrol locations where youth may gather to memorialize the 
deceased and/or engage in risky behaviors such as drinking or drug use 

  • Mobilizing parents to assist in monitoring youth who come to their homes and neighborhoods 

  • Reaching out to other groups and businesses in the community where youths gather, such as 
recreation centers, religious organizations, sports leagues, movie theaters, and diners 


The committee should also consider the gaps in existing resources and identify additional resources that may be needed, such as: 


  • Creating a position for a suicide prevention resource coordinator 

  • Hiring or contracting for additional counseling staff in a affected schools 

  • Hiring staff to provide screening programs in a affected schools, such as Columbia Teen Screen 

  • Developing alcohol and drug programs for youth 

  • Developing teen centers where youth can come together and engage in social and recreational 
activities with caring adults 

  • Creating a public awareness campaign or website to educate the community about mental 
disorders, substance abuse, and other at-risk behaviors, and to decrease stigma and increase help-seeking. Examples of safe messaging can be found at http://www.sprc.org/library/SafeMessaging nal.pdf 

  • Creating public service campaigns to educate the community about suicide risk factors, warning signs, and local resources for those at risk
  • Identifying ways to reach at-risk youth who are not in the education system, such as recent graduates, dropouts, or those in the juvenile justice system
  • Identifying and implementing ways to reduce access to means
  • Exploring eligibility for additional sources of funding, such as a U.S. Department of Education School Emergency Response to Violence (SERV) grant, awarded to school districts that have
  • experienced a traumatic event and need additional resources to respond.

Bringing in Outside Help

Particularly when dealing with possible suicide contagion, school crisis team members should remain mindful of their own limitations, and consider bringing in trained trauma responders from other school districts or local mental health centers to help them as needed.

In particularly complicated situations (and provided that sufficient funding is available to cover any applicable fees), schools may even consider bringing in local or national experts in suicide postvention for additional consultation and assistance. Such steps should generally be taken in consultation with the community committee, and all outside experts must of course be carefully vetted and references checked. Organizations that can provide crisis response, postvention consultation, training, and/or can put schools in touch with appropriate experts include:

National Emergency Assistance Team of the National Association of School Psychologists http://www.nasponline.org/resources/crisis_safety/neat.aspx

National Institute for Trauma and Loss sponsors a TLC Referral Directory of certified trauma and loss specialists and consultants. Note that directory is accessible to TLC members only. http://www.starrtraining.org/online-referral-directory.

  • The Dougy Center: National Center for Grieving Children & Families http://www.dougy.org 

  • Riverside Trauma Center http://www.riversidetraumacenter.org 

  • Boston Children’s Foundation http://www.bostoncf.org 

  • Services for Teens at Risk (STAR) Center, University of Pittsburgh http://www.starcenter.pitt.edu 


Many states have other resources available; check with your state office of education. The Suicide Prevention Resource Center maintains contact information for selected individuals working in suicide prevention in each state who may be able to assist you in identifying local experts (http://www.sprc.org/stateinformation/index.asp). We regret that neither AFSP nor SPRC are able to provide individual technical assistance in these circumstances. 


Going Forward

In the ensuing months, schools should consider implementing:

  • Suicide awareness programs to educate teachers and other school personnel about the 
symptoms of depression and the causes of suicidal behavior in young people 

  • Programs to educate students themselves about the symptoms and risks of depression, anxiety, 
substance abuse, and conduct disorder 

  • Gatekeeper training programs, which teach laypeople the practical skills for identifying and 
referring those who may be at risk, and can be made available to those in the community who 
work with young people such as youth group leaders, coaches, clergy, and parents 

  • A school-based suicide prevention program 


A database of such programs that have been determined by expert peer review to reflect best practices is available at the Best Practices Registry for Suicide Prevention (BPR), maintained by SPRC and AFSP and available at http://www.sprc.org. 


Another source is the National Registry of Evidence-Based Programs and Practices, maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services.

While few of the programs are specific to suicide prevention, this database includes mental health interventions that have been scientifically tested. Available at http://www.nrepp.samhsa.gov. 


Some schools may also wish to take collective action to address the problem of suicide, such as participating as a team in an awareness or fundraising event to support a national suicide prevention organization or local community mental health center. 


Ways to Intervene

Know the escalation process for your school. Escalate as appropriate. 

Be prepared to drop everything to take time to deal with the situation. Take every complaint and feeling the child expresses seriously. Do not attempt to minimize the problem by telling him/her everything they have to live for. This will only increase feelings of guilt and hopelessness. 

Be calm, supportive, and nonjudgmental. Listen actively and encourage self-disclosure. It is okay to acknowledge the reality of suicide as a choice, but do not “normalize” suicide as a choice. Assure the student that he or she is going the right thing by confiding in you. 

Do not express discomfort with the situation. Your willingness to discuss it will show the person that you do not condemn him or her for having such feelings. 

Stay with the student. Never leave him/her alone until further action has been taken. If you are talking to someone via phone, do not hang up; get someone else to call for help on another line. 

Recognize that talking about suicide will not plant the idea! Your questions show that you are paying attention and that you care. 

Ask direct, straightforward questions. (“Are you thinking of suicide?”) Be aware that students will usually respond “no.” 

Ask questions to assess lethality. 

o What has happened to make life so difficult? 

o What has been keeping you alive so far?

Practical Recommendations and Interventions: Suicide

o Are you thinking of suicide? 

o Do you have a suicide plan? (If so, at higher risk) 

o Have you attempted suicide in the past? 

o Is there anyone to stop you? 

o Do you use alcohol or drugs? (If so, at higher risk) 

o When you think about yourself and the future, what do you visualize? 

o Is the means available to you? (If so, at higher risk) Remove the means if possible. 

o What do you think the odds are that you will kill yourself?

Consider the SLAP method of determining the risk of the student’s plan: 

S = How (S)pecific are the details of the plan? 

L = What is the (L)evel of lethality of the plan? (Guns vs. aspirin) 

A = What is the (A)vailability of the proposed method? 

P = What is the (P)roximity to helping resources?

Try to get the person to discard the lethal implement by requesting strongly that they do so, but do not ever attempt to physically restrain a suicidal person who is armed with a gun, knife, or other dangerous weapon. 

Take a positive approach. Emphasize the person’s most desirable alternative. Help the student see the temporary nature of the problems and that the crisis will pass. Explain that suicide would be an absolutely permanent resolution to the situation. However, remember that as a teacher, you are not a trained therapist. Your more immediate job is to serve as a referral agent to help the student get the services they need. 

Identify social supports available to the child and ask him/her is he/she has talked about this with any of them – often a child contemplating suicide is unaware of the different social supports (e.g., counselors, family, friends) that are available. 

Mention the person’s family as a source of strength, but if they reject the idea, back away quickly. For children, the source of pain is usually either the family or the peer group. When you know which it is, you are in a better position to help or refer for help. 

Use constructive questions to help separate and define the person’s problems and remove some of their confusion. To help the person understand their situation, use active listening and respond empathically. (“It sounds like you feel…”) 

Provide reassurance that help is available, these feelings are treatable, and that suicidal feelings are temporary. 

Make crisis management decision. Be decisive. Rapid decision making on the part of the intervener is extremely important. 

o Report the incident to the appropriate school personnel.

Practical Recommendations and Interventions: Suicide 

o Write contracts. (Seek the guidance of a counselor or psychologist as to what is appropriate. Also be aware of your school’s policy regarding such contracts.) If you do not use a contract, see if the student will agree to a verbal promise not to commit suicide. 

o Notify parents. 

o Consider hospitalization. 

o Organize suicide watches. 

Always enlist the help of a health care professional – do not keep the person’s threat a secret, but do respect their privacy. 

Actions to Avoid: 

Do not promise anything that cannot be delivered. This is a situation where it is never appropriate to promise confidentiality. 

Do not ignore or lessen a student’s suicidal threat. 

Try to avoid sounding shocked at a student’s suicidal thoughts. Do not stress the shock, embarrassment, or pain that the suicide may cause their family before you are certain that is not exactly what the student hopes to accomplish. 

Don’t moralize. 

Do not argue with a student who may be suicidal. You may not only lose the debate, but also the person. Don’t criticize, ridicule, or infer that the person is crazy. 

Additionally, do not tell students in this situation that you “know how they feel” or relate personal stories. 

Don’t be concerned by long periods of silence. Allow the student time to think. 

Do not ignore your own intuitions about a student’s behavior or changes. 

Do not try to handle the situation alone. Do not attempt in-depth counseling. Contact a professional to provide more extensive counseling.

TEEN SUICIDE PREVENTION:

Frequently Asked Questions

Sources: Michelina Gautieri, Psy.D., Marin County Community Mental Health; Diane Suiffridge, Ph.D., Family Service Agency; Margaret Perlstein, M.F.T., Teen Mental Health Board; Jessica Potter, L.M.F.T., Bay Area Community Resources; National Institute of Mental Health; Teen Life and Tandem Journey

Question: Is it possible to predict suicide?

Answer: At the current time there is no definitive measure to predict suicide or suicidal behavior. Researchers have identified factors that are associated with higher risk for suicide. These include mental illness, previous suicide attempts, family stress and dysfunction, family history of suicide, physical or sexual abuse, family violence,

traumatic death of a loved one, and impulsive or aggressive tendencies. Alcohol and substance abuse can contribute to suicidal behavior. Substance abuse can be common among teens prone to be impulsive, and among those who engage in many types of high risk behaviors that result in self-harm. In addition to being depressed, those who

are dependent on substances are also likely to have social problems. Suicide is a relatively rare event and it is therefore difficult to predict which persons with these risk factors will ultimately commit suicide.

Q: What are the most common warning signs that somebody is seriously considering suicide?

A: The most common signs that somebody may be at risk for suicide are:

  • A previous suicide attempt
  • Talking about being dead or wishing they were dead, how others would be happier if he/she were dead or how much better off others will be when he/she is gone.
  • Repeatedly engaging in very risky or dangerous thrill-seeking behavior.
  • Extreme mood swings; very depressed episodes followed by happy episodes with no clear reason for the change.
  • Refusal to accept praise or compliments
  • Regular expressions of worthlessness, helplessness, sadness and/or loneliness.
  • Drastic changes in habits, friends, or appearance, i.e.; new friends, skipping school, dropping out of favorite activities, and no longer caring about appearance or cleanliness.
  • Changes in weight, sleeping habits, and physical activity.
  • Withdrawing from friends, family, or activities that once gave the person pleasure or a sense of identity.
  • A sudden, unexpected and tragic event or the anniversary of such an event accompanied by a uncharacteristic withdrawal and/or depression.
  • “Getting the house in order” – e.g., giving away cherished belongings to close friends.

Q: In regard to warning signs, what time frame do these changes in behaviors typically present themselves?

A: Typically, warning signs represent a change that takes place gradually over a few weeks or months although they can also occur suddenly in response to an upsetting event.  If the behavior change lasts for more than two weeks, it is advisable to consult with a professional for guidance about how to help the teen. It’s important to notice any changes in what is normal for your child. If the changes continue for a week or more, it is time to start a conversation WITHOUT judgment. If the teen refuses to talk, they can be given a choice of who they will talk to. Coming right out and asking directly “Are you having any thoughts about suicide?” is okay. Many teens and adults have thoughts about not wanting to live anymore. The danger is when this thought persists for more than 4-5 days, AND when the person has a plan or the means to carry out a suicide. If they have a plan, they need to be screened and possibly hospitalized.

 Q: What can be done about suicides that do not have any of the “obvious”

warning signs?

A: The best prevention is for a teenager to have open communication with a caring adult who can listen without judgment to the concerns of the teen. Despite this, sometimes teens are unable to let someone know how much distress they feel. Some of the preventive actions that parents can take are to limit their teenager’s access to guns,

knives, alcohol, prescription pills and illegal drugs. Other steps parents can take is to know who their child’s friends are and to networking with the other parents on a regular basis. Do not be afraid to keep track of your child’s whereabouts and communications. They may complain about their privacy, but it is the parents’ job to keep their child safe.

Q: Does suicide does tend to run in families?

A: It has not been definitively proven that there is a direct genetic component involved in suicidal thinking and attempts. What is known is that mental illness runs in families, and mental illness increases the likelihood of suicide attempts. If an adolescent shows signs of suicidal thinking and the family has a history of mental illness, especially clinical depression, there is increased reason for concern.

Q: At what age should education about suicide prevention start?

A: Young children up to age 11 can benefit from learning how to identify their feelings and where to go for help when they feel bad. The risk of suicidal thoughts and behavior increases in adolescence and young adulthood so education about warning signs for themselves and their friends is especially important for youth from age 11 through 18 and their parents.

Q: Are teens who have previously attempted suicide at highest risk for suicide

completion?

A: No. While a previous suicide attempt does increase the likelihood of a future attempt being successfully completed, the majority of successful suicides are first-time attempts.

Q: Are teen suicides and suicide attempts clustered?

A: When one teen decides that suicide is a solution to his or her pain, other teens may be influenced to follow suit. Studies have indicated that the more desperate and hopeless a particular teen community feels about its situation, the more likely members of the community are to influence each other’s suicidal thinking and action. Following

exposure to suicide or suicidal behaviors within one’s family or peer group, suicide risk can be minimized by having family members, friends, peers, and colleagues of the victim evaluated by a mental health professional. Persons deemed at risk for suicide should then be referred for additional mental health services.

Q: Do all suicidal people talk about killing themselves before they try to do it?

A: No. While it is very common for suicidal people to tell someone what they are planning, it is possible for somebody to be thinking about suicide without telling a soul. In the absence of other warning signs, a suicide threat is not even considered the most credible indicator of suicide risk, but any talk of suicide should be brought to the

attention of people who can intervene: parents, teachers, school counselors, social workers, even the police.

Q: Are all suicide threats real or is it usually just a cry for attention?

A: While many teens threaten suicide to get attention, it is impossible to make that definitive determination. A suicide threat must be taken seriously. If you hear someone is considering suicide, be it directly or through the rumor mill, make sure you alert a trusted adult who is able to better assess the situation: a parent, teacher, school counselor, pediatrician or member of the clergy is a good choice.

Q: How do I know when to take a friend’s suicide threat seriously?

A: The best rule to follow is if a friend says that they are going to kill themselves you should take it seriously. Turn to a trusted adult who is in a position to get help for your friend if the threat is real. Obviously there are situations where somebody may say, “I wish I was dead!” and not mean it at all but it is better to be safe than sorry. No harm

ever came from caring too much!

Q: What should I say to my suicidal friend?

A: Tell the friend that you care about them and that he or she is an important part of your life. Ask the friend to reach out for professional help. Don’t leave the friend alone; get other friends involved if you must, and alert a parent, trusted adult or school official who is able to intervene and get the friend some professional help.

Q: What should I do to stop them?

A: Do not take it on yourself to talk your friend out of it. Just be there to help your friend through this troubling time. Stay until a parent, trusted adult or school official administrator is able to take control of the situation. If the threat is an obvious emergency or if your friend is in imminent danger call  911 right away.

Q: How do we encourage students to report signs of a problem without them

feeling that they are snitching?

A: Teens talk about “the deadly secret” of being put in the position of having to keep a friend’s confidence without “snitching”. Explain that going to an adult when they have concerns for a friend’s safety is not snitching, it’s the mature and responsible thing to do. Choosing not to “snitch” could result in your child living with the thought that they should have told someone, but waited until it was too late! Tell your child that if they have concerns about a friend, you are willing to discuss their concerns before jumping in to take action.

Q: My friend is saying he/she wants to commit suicide after killing all the people who make him/her miserable, what should I do?

A: Do not take it on yourself to decide if your friend’s threats are credible. This is a burden you need not bear. Let adults and trained professionals assess the situation and determine how valid the threat is and what should be done next. If you fear reprisal from your friend, make sure that you make this clear when reaching out for help. This is

factor that should be considered by the school administrators and police.

Q: How can a parent handle emotional blackmail, e.g., when a child threatens

suicide if not allowed to do a particular activity or attend an event?

A: Treat this behavior calmly,but take it seriously. Explain to your child that if he/she would consider suicide, then they have much more serious issue to deal with than going out with their friends. If your child is attempting to manipulate you, then he/she should confess fairly quickly. Tell your child that you will consider allowing the freedoms they are requesting when they can discuss them without manipulations at that level.

Q: How does a parent open up the conversation with a teen about depression, drug use and suicide?

A: Depending on your relationship with your particular child, kids can be quite resistant to bringing up anything serious or “touchy-feely” with their parents. The recent tragedies give you a doorway to enter into the conversation but that door won’t stay open forever. Bring up this topic when you and your child are spending relaxing time

together, away from homework and chores and other stressors. Speak about your own reactions and thoughts about recent events and ask your child what he/she sees, thinks, feels, and knows. Make it a conversation and NOT a lecture. If you sense your child shutting down in the conversation, just say you are really interested in hearing his/her thoughts and that you are open to going back to the subject any time they would like. This isn’t a conversation a parent should push but is best brought up away from the heat of the moment and in a way that does not feel like it’s coming out of context. If your child does not back out of the threat, treat it as real and consider a trip to the Crisis Unit or call 911. You don’t want to give in to a manipulation but you don’t want to under-react to a potential real threat. Better safe than sorry. At the Crisis Unit, a professional will assess your child. Remember that teens tend to have poor impulse control and may act out a suicidal gesture, not really intending for it to succeed.

Nevertheless, sometimes those gestures DO succeed.

Q: What assurances can you offer parents as they navigate these serious mental issues with their child? The fear of stigma often keeps parents from sharing information with teachers/school.

A: Confidentiality is definitely part of the relationship between a therapist and his/her clients. School staff members are also expected to maintain confidentiality about students and their family’s issues. If your child is suffering from emotional issues, these are going to impact his/her school attendance/performance. Sharing what is going on

may be the best approach. Otherwise, your child may be misunderstood and even penalized for things that may not be under his/her control. This is the time when you want to get as much support as you can for your child. Forge an alliance with school personnel who are most likely to come in contact with your child. Without revealing

every detail, share with them that your child is experiencing some emotional challenges and you need the support of the people who care for him/her within the school. Stigma is clearly an issue in our society. However, there is a lot more understanding and acceptance of mental health issues now than in the past. Withholding information

for fear of stigma can ultimately be damaging to your child, and it also perpetuates the stigma.

Q: What can we do as a community when we see a child that needs help but we know the parental support is not as good as it could be?

A: Kids, and especially teenagers, can be responsive to a caring adult, even if that adult isn’t their parent. Alert the school administrator to concerns about any child. They may be able to connect the student and family to a counselor at school. Under certain circumstances, teenagers may receive therapeutic services without parental consent.

Consider if some adult (teacher, coach, minister) in the community has a good relationship with that child. Can that individual be supportive in a parental way without usurping the parent’s authority? Even if it can’t come from the parent, it’s important for kids of all ages to have a connection to some responsible adult. It may be that the parent could use some support as well. In this circumstance, consider if there is someone who can approach the parent with their concerns. It’s not unusual for parents to want to minimize emotional issues with the hope (whether conscious or unconscious) that their child will grow out of it. If your attempts to refer the child to school services or other community supports does not appear to have improved the situation, as a last resort, consider making a call to Children Family Services and let them know of your concerns about the child.

Q: How can stress be reduced for students with high academic expectations?

A: Acknowledge that there are many ways to be successful in the world. Even if students don’t go to the best four-year college right after high school, they can still achieve their dreams. Going to a community college can eventually be the path to their goal of a four-year college. Teens need to slow down. Pressure and stress do not help

any of us. Find out what a teen is really passionate about and encourage that positive activity. Students who get to do something they love to do will usually be better students. Remember that having a happy and healthy child is more important than where they receive a diploma.

Parents: How to Talk to Your Teen About Mental Health and Depression (Without Saying ‘Mental’ or ‘Depression’)

Sure, I understand ups and downs are a normal part of growing up.  I also understand that it is difficult to distinguish normal teenage moodiness and depression.  Many teens have articulating  what they’re going through, and they probably don’t want to talk about it either, and certainly not to you.  Teens NEED two questions asked:

Do you care about me and Can I trust you?

You answer these two questions and you have a better chance of your teen opening up to you. 

Rates of teen depression increase sharply during adolescence, peaking around 16 years old. The exact reasons for the rise in depression during this time is unknown but it’s widely accepted that a number of factors contribute, including school transitions, academic and social stress and hormonal changes. Social media, cell phones, internet – dopamine and the rights and privlages we as a society have given them, yet their incapable of emotionally handling these stresses that come with the different platforms.  Also, the expectations of parents, teachers/schools, and the pressures they’re putting on themselves . . . And for what? 

Add to this their developmental goals of figuring out who they are, where they fit in and establishing their independence and it’s clear that teens have a lot going on. Parents, you play the MOST SIGNIFICANT role in the self-esteem of your teen than any other adult, yet, when I ask teens who their number one trusted adult is, rarely is it their own parents.

Here is the Conversation That Will Help Protect Your Teen

One of the best things you can do for your teen in your life is to let him or her know that you’re available to talk on their terms.  On their terms!  Here are some ideas for how to make that happen:

1.     Be Present

Let them know you’re there for them unconditionally and whenever they want – no limits. Be careful not to ask too many questions though. You don’t want them to feel crowded, lectured, patronized, or that you are trying to fix their thoughts and emotions.  Let them feel , but let them figure it out knowing you are always there to listen and offer advice if they want.  Ask permission first, but always validate their feelings.

2.     Send Invitations

Starting the conversation is the easiest part or it should be. Here are a few ideas to get things started:

    • ‘Are you okay? I’m here if you ever want to talk.’
    •  
    • ‘It’s really normal to feel stressed/
    • cranky/ sad/ tired sometimes but if it
    • gets to the point where you’re feeling
    • like that all the time we should talk about it.
    • You don’t have to feel like that and
    • there are ways to feel better.’
    • ‘You seem a bit down/ stressed/ tired/
    • sad lately. Is that how you’re feeling
    • at the moment?’ Then, depending on the answer,
    • ‘Would you like to talk about it?’ or
    • ‘Well I’m here if you ever need to talk.’ 
3.     Validate them.

Acknowledge that high school can be tough and that it’s all part of the process in growing up. Acknowledge the things that might be going on –

‘I know that you want to do well so I understand that you might feel the pressure of school/ staying on the team/ fitting in.  Everyone’s going through the same thing so there might be some crazy stuff that happens with your friends.

It’s pretty normal. I’m here if you ever want to talk.

4.     Give them an easy out.

Instead of a car trip being about you “The Cheuffer” have the duration of a car trip as the time limit so they know there is an easy end to any difficult conversation and that they have control. Let them know that you will only talk until you pull into the driveway and then they can decide whether or not to keep the conversation going. It’s completely up to them – no questions or argument from you. ‘Do you think we can talk about how you’re travelling. Let’s do it like this. Let’s chat until we pull into the driveway and then I promise we’ll talk about something else if you want to. Totally up to you.’

5.     Your physical presence can make a difference.

This can depend on the teen and the situation. Sometimes your teen might respond better if you avoid eye contact. Try starting the conversation in the car or while you’re doing something else (like cooking dinner) rather than when sitting down and facing them. Then there might be other times when they’ll appreciate the one on one close attention from you. Maybe at night before bed and you are sitting on the edge of the bed (this is a great time where trust and respect are strongly developed). When it’s late and dark outside, the rest of the world seems a bit more removed – no distractions, no expectations. They won’t always talk of course – sometimes they’ll have nothing to say, or they might not feel like talking – but if they’re going to talk, this seems to be the time they do. 

6.     Be gentle but persistent and available but not intrusive.

Your teen might not open up straight away – and that’s okay. Keep trying but be mindful of pushing too hard. It’s a tricky line this one. The main thing is to keep making yourself available for when they’re ready.

7.     Don’t try to talk them out of their depression.

Even if their thinking seems irrational or their thoughts trivial, it isn’t that way to them. Validate them, ‘It’s bothering you isn’t it,’ or ‘I can see how upset you are,’ so they know they can come to you again.

Teenage Depression: The Warning Signs

Knowing the warning signs is important because with early detection plenty can be done.

If you’re not sure whether the teen in your life is depressed or just going through the usual growing pains that come with adolescence, consider the duration and severity of the symptoms and how different your teen is acting from his or her usual self.

Teenage depression can look similar or very different to depression in adults. The usual signs of depression are: 

  • mood changes – sadness or irritability
  • a sense of hopelessness
  • tearfulness or crying
  • withdrawal from social and family relationships
  • loss of interest in activities
  • changes in sleep habits – sleeping more or less, change in waking times (later, earlier, during the night)
  • changes in appetite and eating habits
  • restlessness
  • feelings of worthlessness and guilt
  • lack of enthusiasm or motivation
  • tiredness and fatigue
  • difficulty concentrating
  • suicidal thoughts
For teens the warning signs can look different to this:
  • They may be negative, cranky, irritable, angry, easily frustrated or prone to outbursts. Often, depressed teens come across primarily as irritable and cranky, more than sad.
  • They may complain of aches and pains (such as headaches or tummy aches) for which there is no medical explanation. 
  • They may feel misunderstood or highly sensitive to criticism. Because of their feelings of worthlessness, depressed teens can be extremely sensitive to failure, rejection or criticism. Overachievers are particularly vulnerable.
  • They might withdraw from some, but not all, of their relationships. Depressed adults tend with pull away from relationships generally but the withdrawal is not as clear in teens. They might pull away from some and keep others, start mixing with a different crowd or just pull away from their parents.
  • There may be problems at school. Difficulty concentrating and low energy may lead to attendance problems, poorer grades and frustration with school work in previously good students.
  • Drug and alcohol abuse.
  • Low self-esteem that might play out as expressions of ugliness, shame, unworthiness and failure.
  • They may spend excessive time on the computer.
  • They may engage in risky behavior – recklessness, drinking, unsafe sex.

Remember that these warning signs can look like a normal part of adolescence and in many cases that’s exactly what it will be. The symptoms exist on a spectrum and the main thing is to be alive to the duration and severity of the symptoms and the departure from whatever is ‘normal’ for your teen.

If You Suspect Your Teen is Depressed
  • The most important thing is to let them know that depression and anxiety is treatable. The sense of helplessness that comes with depression doesn’t only touch those who are struggling with depression, but also those who love them. Know that even if it doesn’t seem as though the things you are doing are making a difference – they are. See here for ways to support your teen if he or she is struggling with depression. 
  • Things can change and they won’t always feel the way they do today. Let them know this. It’s critical and will make a difference.
  • If there’s any chance your teen might be suicidal, ask them directly if they are having thoughts of suicide. Many people avoid asking the question for fear it will put the idea into their head, but it won’t. It might be the most important question you ask them. If they are suicidal, help them seek professional help right away through a counselor, doctor or hospital.
  • Help them to challenge the negative thinking that contributes to depression.
  • Exercise can protect against depression and for mild to moderate depression, exercise causes the same changes in the brain as antidepressants. A 20-30 minute walk five times a week will make a difference.
  • Have your teen assessed by a doctor to determine whether or not medication is appropriate. Medication can be very effective but the effects of antidepressants on the adolescent brain aren’t fully known. Close monitoring is important particularly in the first two months of treatment to pick up any worsening of symptoms, suicidal thinking or further changes in mood or behavior. If medication is recommended, it should always be used as part of wider treatment plan that includes counselling (to equip them with the skills to protect themselves from depression) and lifestyle factors (such as diet, exercise, mindfulness). Medication isn’t a magic bullet and changes generally won’t be seen for at least a few of weeks. 
  • Understand that depression is physiological. It’s NOT a deficiency in personality or character. Living with a depressed teen might expose you to rejection, conflict, despair and extreme sadness yourself. Living with someone who is depressed requires a heroic effort from those who love them. Understand that your teen is still the child you’ve always known and they aren’t pushing you away or hurting you on purpose. They’re hurting. It’s just what depression does.
  • Do whatever you can to accommodate your teen socially. One of the symptoms of depression is withdrawal from relationships, but isolation will make their depression worse. Anything you can do to support them in maintaining friends or getting out will be important. 
  • Be patient and don’t compare. Depression can take aim at anybody. It is not a reflection on parenting or personality. The most loving, involved parents can have a teen with depression. It’s chemical. It’s important for your own sake that you don’t compare yourself or your family to others. Your teen will come back. Be patient and don’t be disheartened by temporary setbacks – it’s a normal part of the recovery.
And finally …

I’ve yet to meet a parent who isn’t racked with self-doubt now and then, wondering if they’re getting it right. Adolescence seems particularly adept at taking any self-doubts we have and flourishing them to spectacular proportions.

Whether your teen is depressed or not, if you are arming yourself with information and making yourself available, know that you’re doing what they need you to do. They’re lucky to have you. Deep down inside them, whether they show you or not, they know it too.