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Suicide Prevention

and

Awareness

This product was supported in part by grant number H79SM088086 from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The content of this publication does not necessarily reflect the views or policies of SAMHSA or the U.S. Department of Health and Human Services (HHS).

for

Parents and Families

Center for Distance

and Online Learning

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COLLECTIVE IMPACT PARTNERSHIPS

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Tips for Trainers

Prepare for your specific audience of parents. Referral and intervention steps may differ for each school.
Modify the PowerPoint to include the appropriate referral process for the audience, and the resources that serve their communities.
Address the referral process and any obstacles to supervision
Provide a parent handout on suicide prevention and non-suicidal self-injury.

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Tips for Trainers Cont’d

Coordinate with administrator/crisis team and parent liaison.
Arrive early to deal with crises.
Prepare audio/video for training:

Computer setup/Wires/Power cords
Microphones & sound

Plan to stay after your presentation to address individual questions.
Allow enough time for participants to fill out evaluations.

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Core Components for Parent/Family Training

Common myths about suicide
Just the facts
Protective factors
Risk factors & warning signs of youth suicide
Who is the highest at risk?
Suggestions for responding to suicide risk
Appropriate ways to interact with at risk youth
If your child experiences a loss by suicide
Resources

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Myths: A Brief Quiz

True or False?

If a student is really intent on killing themselves, there is nothing anybody can do to stop them.

FALSE!! Suicide is preventable. A suicidal youth just wants the pain to end and death seems to be the only way out. Any act of kindness can potentially save a life!

True or False?

If we talk about suicide, we may give students the idea to kill themselves?

FALSE!! Research shows talking about suicide effectively lessens a young person’s anxiety and does not put “ideas” in their heads

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Myths: A Brief Quiz Continued

True or False?

Those who talk about suicide are “all talk” and are just looking for attention?

FALSE!! Most suicidal individuals do give some warnings that they are in emotional pain and are thinking of hurting themselves. Even if they are seeking attention, they are doing so because they are IN NEED OF HELP! WE can help them.

True or False?

Only experts can prevent suicide.

FALSE! You too can save lives. That is the purpose of this presentation….to provide you with information about suicide awareness and warning signs. You see the students on a daily basis…we rely on you!

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Those who attempt suicide really want to die.
Those who have attempted suicide are at low risk of actually dying by suicide.
Most suicides occur with little or no warning.
Improvement following a suicidal crisis means that the risk is over.
Others?

A Few More Myths

Those who attempt suicide really want to die.

Kids are ambivalent until the very last moment

Suicidal child wants to be out of pain.

Those who have attempted suicide are at low risk of actually completing a suicide.

Actually they may be the highest! The best predictor of future behavior is past behavior. This is a moment to say “there are no predictors of youth suicide so we must be vigilant with even low risk kids

Most suicides occur with little or no warning

Actually, most youth say something, do something, write or draw something that comes to the attention of someone.

As many as 8 out 10 kids say something, do something, write something or draw something that has the potential to be heard or observed by an adult or peer.

Improvement following a suicidal crisis means that the suicide risk is (thankfully) over.

FALSE, students need to be monitored as kids are not suicidal 24/7 but in small pockets of time.

Others?

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JUST

Suicide is a leading cause of death for 10-24 year olds
More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease, COMBINED.
Males are 4x more likely to die by suicide, females 3x more likely to attempt.
For every death by suicide of a young person, 250 youth attempt.
Four out of Five teens who attempt suicide have given clear warning signs.

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Protective Factors

Protective factors include…

having social supports*
feeling connected *
being cognitively flexible
willing to obtain treatment
strong spiritual or religious ties*
being physically healthy*
participating in extracurricular activities
being hopeful, having coping strategies creates RESILIENCE.

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Screenagers

Prevention, education and digital citizenship are key.
Develop a family plan with input from your children that sets limits.
Dramatic changes with regards to screens will be challenging.
Parental modeling is important.

Kids spend an average of 6.5 hours a day on screens
Basic rules for parents:

No screens in the bedrooms

75% of teens get inadequate sleep

Family meals without devices

Face to face interactions increase empathy

Set time goals for studying and reward with breaks that include devices

Multitasking is poor for retention and academic outcomes

Phones and devices away in the car & crosswalks

More than half of kids report watching parents text while driving

Prevention, education and digital citizenship are key
Develop a family plan with input from your children that sets limits
Dramatic changes with regards to screens will be challenging
Parental modeling is important
Apps!

Tips for Parents

Online activities are not just your child’s business
Discuss online behavior with them and what information is appropriate to share
Demand to know the online communities and your child’s password
Be up front that you will investigate their postings, profiles, website etc. because you care! Take Charge!
Numerous programs allow parents to monitor cell phone and internet activity

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Enhances your child’s internal resources

More likely to seek help
Enhanced ability to regulate emotions

Enhances your child’s external resources

More likely to have peers/adults notice
More likely to ask for help of trusted adults

Access to resources at school and community

Positive Connections at School

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Youth Suicide in CA: 2022

2^ndleading cause of death for 10-14 year olds, 3rd leading cause of death for 15-19 year olds
Over twice as many people die by suicide than by homicide in CA
Rate all ages 11.0 #45 in US (14.8)
Rate 15-24yo 8.8 #45 in US (13.6)
Roughly one in ten suicides in the US occur in CA
Most common method: strangulation, however firearms are the leading cause of death for youth in America
Highest Risk Youth: African American, Hispanic & White youth; LGBTQ+

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Los Angeles�Youth Risk Behavior Surveillance Survey 2021

Overview Youth Suicide

US

42.3

22.2

17.6

10.2

2.9

LA MS

2019 Data

26.8

17.9

12.3

40.9% felt sad or hopeless

17.7% seriously considered suicide

15% made a plan

9.4% made one or more attempts

3.5% actually got to medical help

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Trusted Adults: Youth who have an adult to go to for help are 3.5x LESS likely to attempt suicide.
School Safety: Youth who feel safe at school are 3.2x LESS likely to attempt suicide.
Extracurricular Activities: Youth who participate are 1.7x LESS likely to attempt suicide.

Factors that Can Help Reduce Youth Suicide Attempts

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There is no single predictor of youth suicide.
Risk factors come together in a perfect storm.

Eight Risk Factors:

Alcohol & substance abuse
Accessibility to means (firearms)
Depression/Comorbidity
Previous suicidal behaviors
History of trauma, adverse childhood experiences (ACES)
Hopelessness
Impulsivity
History of Nonsuicidal Self-Injury

Risk Factors of Youth Suicide

There are no predictors of youth suicide although the best predictor of future behavior is past behavior so if a student has made an attempt before they are at greater risk of attempting again.

There are as many as eight different factors that come together in a perfect storm

Its best to describe these seven factors as eight lights on a popular street. To go from thinking about suicide to attempting suicide all the lights have to turn green in a perfect storm. The dangerous part is that if all the lights turn green, a teen can go from thinking about suicide to attempting in four minutes! Especially if the second light, presence of a firearm, is green.

While we find the same risk factors present in youth as we do in adults (depression, alcohol& substance abuse, previous behaviors), it may be that hopelessness and impulsivity may play a larger role in suicidality.

Alcohol & Substance abuse

Alcohol intoxication exacerbates teen stress and their psychopathology and is associated with suicide by firearms
Substance abuse for teens often co exists with other disorders most likely depression
Youth who use alcohol and/or illicit drugs report higher rates of suicidal ideation, are 10x more likely to attempt suicide, and 4x more likely to die by suicide
Among youth who died by suicide, up to 75% met the criteria for an alcohol or substance use disorder
50% of youth that die by suicide are “legally” intoxicated at the time of death.

Firearms

Firearms has been identified a the #1 method in many places but not CA or Los Angeles where death by strangulation is #1. States with more stringent gun laws such as CA generally have lower suicide rates however, gun responsibility is imperative everywhere!
1 out of 2 kids do not go on to another method if the gun is not accessible in the home

Depression

30% in Los Angeles report feeling so sad or hopeless over the past year that they affected their daily activities
The majority do not receive services
Co-occurring disorders

For girls: depression and alcohol and substance abuse
For boys: depression and conduct disorder (ED boys in your special ed classrooms)

Ignited by precipitating events
Effective treatments include Cognitive Behavioral Therapy and medications

Previous attempts

The best predictor of a future attempt is a past attempt

History of trauma

One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior.
Trauma can impact school performance and learning
Traumatized children can experience physical and emotional distress
Treatments include Trauma Focused-Cognitive Behavioral Therapy & Cognitive Behavioral Intervention for Trauma in Schools

Hopelessness

Impulsivity

Nonsuicidal Self-Injury (NSSI)

Research indicates the longer a youth has engaged in NSSI behaviors, and the variety of means may be a predictor of a suicide attempt
Maladaptive coping strategy
Generally assesses at low risk for suicide
Episodic associated with emotional regulation
Repetitive NSSI associated with history of trauma, Adverse Childhood Experiences
Suicidal risk increases with number of years engaging in self injurious behaviors and number of methods
Treatment: Dialectical Behavior Therapy
Never tell a young person who engages in NSSI to “just stop”!

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High Risk: Cultural Perspectives

Caucasian Youth

Males

Native American/Alaskan Native Youth

American Indian/Alaskan Natives have the highest rates of depression and suicide in the US
Although suicide rates vary widely among individual tribes, it is estimated that 14 to 27 percent of AI/AN adolescents have attempted suicide.

Hispanic Youth

Latina
Highest in reporting of suicidal thoughts and behaviors

African American Youth
The suicide rate among Black children ages 5 to 11 doubled 1993-2013.
Asian American Youth

Higher rates of depression in Asian adolescent girls strongly associated with acculturation, family/academic expectations

Some cultural perspectives:

Several crosscutting issues must be addressed when providing culturally responsive interventions:

Acculturative stress and protective factors within cultures
The roles of religion and spirituality and the family in culturally sensitive interventions
The different manifestations and interpretations of distress in different cultures
The impact of stigma and cultural distrust on help-seeking.

Hispanic youth

On the Youth Risk Behavior Surveillance Survey, Hispanic high school students, male and female, reported higher rates of suicidal behaviors than the general population of U.S. High School Students. And in addition, there is ample evidence suggesting the Latina teen may be the highest risk for suicide. The percentage of Latinas expressing suicidal thoughts and behaviors was higher than that of White female students and Hispanic male students. Latino youth however, have lower overall rates of suicide when compared to White, Native American/Alaskan Native, Black and Asian youth. Disparities in acculturation between the adolescent and their immigrant parent may contribute to higher suicide risk in Latino adolescents.

African American youth

The American Psychological Association (APA) found from 2001 to 2015, the suicide risk for Black boys between the ages of 5 and 11 was two to three times higher than that of White boys, according to a new research letter in JAMA Pediatrics (Bridge, 2018). Apparently this concerning trend continues through adolescence as reported by the Nationwide Youth Risk Behavior Survey (Kann et al., 2017). The rates of attempted suicide, including attempts that resulted in an injury, poisoning, or overdose, are 1.2x higher among Black boys compared to White boys.

According to the APA report, even professional health care providers have trouble detecting depression among racial/ethnic minority patients. Groups such as African Americans and Latinos are diagnosed with depression less often than non-Hispanic white males, and depression may also present itself differently in young males as irritability, anger, and discouragement rather than hopelessness and helplessness (Hunt & Robles, 2018).

American Indian/Alaskan Native youth

American Indian/Alaskan Natives have the highest rates of depression and suicide in the US with the highest rates occurring in Alaska and the Northern Plains. AI/AN high school students also have higher rates of serious thoughts of suicide, suicide plans, and suicide attempts overall, with AI/AN females having higher rates of these behaviors than AI/AN males. Although suicide rates vary widely among individual tribes, it is estimated that 14 to 27 percent of AI/AN adolescents have attempted suicide.

Depression may have its foundation in brain chemicals such as serotonin and melatonin. The body naturally produces these chemicals when we respond to sunlight. There is much research linking depression rates in Alaska youth to months spent in darkness. Light therapy, or exposing the brain to light at appropriate times during the morning and day, has demonstrated considerable success with Alaskan youth in decreasing the incidence of depression and consequently increasing academic scores.

Native Americans suffer numerous additional risk factors such as devastating economic hardship, victimization, alcohol and substance abuse and exposure to violence and suicide both at home and in the community

Asian American youth

The term “Asian American” encompasses an extremely diverse group of people with various cultures, histories, views of mental illness, and views of suicide. Asian American teenage girls have the highest rate of depressive symptoms of any racial, ethnic or gender group according to a report released by the National Alliance on Mental Illness (NAMI). Major findings involving youth included:

Asian American girls have the highest rates of depressive symptoms of any racial/ethnic or gender group;

Young Asian American women ages 15 to 24 die from suicide at a higher rate than other racial/ethnic groups;

Among Southeast Asians, 71 percent meet criteria for major affective disorders such as depression— with 81 percent among Cambodians and 85 percent among Hmong.

Key issues include barriers to mental health services and negative perceptions of mental health problems particular to AAPI communities. Acculturation refers to the manner in which people negotiate between two or more cultures when one culture is considered dominant and the other culture is perceived to have less value. Acculturation is strongly associated with depression among adolescent Asian Americans.

Among adolescent Asian Americans, there is a heavy emphasis on children meeting parental expectations. As such, studies have shown that adolescent Asian Americans reported a higher frequency of academic and family related worry.¹⁶ This is compounded by emphasis placed on careers in highly competitive areas such as medicine, science, and law, which are viewed as the primary vehicles for social mobility in the US.¹⁶

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“Suicide Rates among ethnoracially minoritized youth (i.e. youth of color) peak before the age of 30, and striking disparities in access to mental health services have been identified in this age group. However, suicide prevention strategies have yet to fully address structural racism as a mechanism in producing disparities in risk, protective factors, and access to quality effective intervention for youth of color.”

– American Journal of Psychiatry, May 2023

“Suicide rates climbed significantly among American Indian, Black, and Hispanic people in 2021 in the wake of the COVID-19 pandemic, a new federal analysis found, even as rates of suicides among White people fell for a third straight year”

– CBS News

Racial Dispartities Regarding Suicide in the News:

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Exposed to Suicide
Depressed
Alcohol & Substance abuse
Bullies & Victims

LGBTQIA2S+
Youth with disabilities

Engaged in Non-Suicidal Self-Injury (NSSI)
Traumatized
Youth in Foster Care/Homeless Youth

At Risk and At Promise Messaging

High Risk Youth as Defined by AB2246 and AB 1767

High Risk Youth

Alcohol/substance abuse

In the U.S., more than 60% of youth report having use alcohol, 40% report having used illegal drugs, and up to 2 million youth meet the criteria for a substance use disorder
Substance use is both a chronic and acute risk factor for suicidal behavior and the probability of suicide attempts increases with the severity of substance use
Youth who use alcohol and/or illicit drugs report higher rates of suicidal ideation, are 10x more likely to attempt suicide, and 4x more likely to die by suicide
Among youth who died by suicide, up to 75% met the criteria for an alcohol or substance use disorder
Substance abuse and suicide rates have both increased for teens
Environmental factors that increase suicide risk also increase substance abuse risk
Alcohol abuse associated with greater frequency and more lethal suicide attempts
Low parental monitoring of teen alcohol intoxication and parental intoxication are associated with teen suicide attempts
Alcohol intoxication exacerbates teen stress and their psychopathology and is associated with suicide by firearms
Substance abuse for teens often co exists with other disorders most likely depression
Protective factors for suicide and substance overlap

Opiate abuse

Dramatic increase in opioid abuse including illicit Heroin and Fentanyl and prescribed painkillers such as OxyContin
Adolescents often believe that prescription medications are not dangerous
CDC reports a 4 fold increase in the number of prescriptions for opioids since 1999 and estimates are that since year 2000, 300,000 have died from opioids
Prevention

Raising awareness of the dangers in communities and families and providing support (CRAFT)
Reducing opioid prescriptions and treating chronic pain without opioids
Safe disposal of prescription medications
Medication assisted treatment such as Methadone and overdose antagonist Naloxone

Eating disorders

Eating disorders (ED)have the highest mortality of any mental illness
Long term struggles with ED and failed treatment result in hopelessness
Estimates are that Anorexia Nervosa increases the suicide risk 5 X while Bulimia Nervosa increases the risk 6X
Those with ED habituate to pain through starvation and complications of purging

Youth Experiencing Homelessness or Youth in Foster Care

1.5 million youth run away or are forced to leave their home each year in the U.S.
Suicide is the leading cause of death for homeless youth
More than 70% of homeless youth report experiencing depression and suicidal thoughts and approximately 50% report a history of suicide attempts
Homeless youth are 4x more likely to have attempted suicide in the past and 3x more likely to have attempted suicide in the last 12 months than non-homeless youth
LGBTQ+ homeless youth report higher rates of suicide attempts (62%) and are more than 2x as likely to die by suicide than heterosexual homeless youth

Children in foster care

More than 400,000 youth are in foster care on any given day in the U.S.
Youth involved in the child welfare system experience higher rates of mental illness and substance use and are at an elevated risk for suicidal behaviors
Foster care youth are 3x more likely to significantly consider suicide, 4x more likely to have made a suicide attempt in the past 12 months, and 5x more likely to be hospitalized following a suicide attempt when compared to non-foster care youth
Foster care youth are 3x to 5x more likely to die by suicide and up to 1/3 of all youth suicides occur among youth involved in the child welfare and juvenile justice systems

Bullies and victims

Children who have been bullied have reported a variety of behavioral, emotional and social problems.
Highest risk has been both bully/victim
Key factor is pre-existing psychopathology
Some gender differences in response to bullying
High risk groups include: Disabled, Race & Religion; LGBTQ+

Lesbian, gay, bisexual, transgender, questioning youth

Higher rates of family rejection & peer victimization

3X more likely to report suicidal ideation
8X more likely to have attempted suicide
6X more likely to have higher levels of depression
Compared to non-LGBTQ+ youth LGBTQ+ youth suicide attempts may be more serious

Depressed; Mental Illness

One in four youth
The majority does not receive services
Co-occurring disorders
Ignited by precipitating events
Of those who die by suicide, 90% have a mental illness and 60% of the time that mental illness is a mood disorder
Effective treatments include talk therapy and medications

NSSI

Maladaptive coping strategy
Generally assess at low risk for suicide
Episodic associated with emotional regulation
Repetitive NSSI associated with history of trauma, adverse childhood experiences (ACE)
Suicidal risk increases with number of years engaging in self injurious behaviors and number of methods
Treatment: Dialectical Behavior Therapy

Traumatized

One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior.
Trauma can impact school performance
Trauma can impact learning
Traumatized children can experience physical and emotional distress
Parents and teachers can help
Maladaptive coping:

Suicidal and/or homicidal ideation
Abuse of others or self (e.g., NSSI).
Extreme substance abuse and/or self-medication
Extreme rumination, hyper-vigilance and/or avoidance behavior
Taking excessive precautions

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“What causes suicide?”

There is no one cause of suicide and kids are not suicidal 24/7 so we must be vigilant in responding to students at all levels of risk.
Typically there are two factors that come together to propel a kid down a self destructive path

A chronic factor such as mental illness, depression or substance abuse that acts as the fuel…and a precipitating event that ignites it.

There are no predictors of youth suicide so no way to know which kid will travel down that self destructive path. It is a result of the coming together of many factors in the perfect storm (see: Risk Factors)

95% of those that die by suicide have some form of mental illness
60% of the time that mental illness is a mood disorder such as depression
Today many students suffer from co-morbidity or two risk factors working together that raises risk exponentially.
For girls: the most common co-morbidity is depression and alcohol/substance abuse (liquor & meth)
For boys: the most common co-morbidity is depression and conduct disorder (the emotionally disturbed male with conduct problems is highest risk in special ed)

Alcohol/substance abuse

In the U.S., more than 60% of youth report having use alcohol, 40% report having used illegal drugs, and up to 2 million youth meet the criteria for a substance use disorder
Substance use is both a chronic and acute risk factor for suicidal behavior and the probability of suicide attempts increases with the severity of substance use
Youth who use alcohol and/or illicit drugs report higher rates of suicidal ideation, are 10x more likely to attempt suicide, and 4x more likely to die by suicide
Among youth who died by suicide, up to 75% met the criteria for an alcohol or substance use disorder
Substance abuse and suicide rates have both increased for teens
Environmental factors that increase suicide risk also increase substance abuse risk
Alcohol abuse associated with greater frequency and more lethal suicide attempts
Low parental monitoring of teen alcohol intoxication and parental intoxication are associated with teen suicide attempts
Alcohol intoxication exacerbates teen stress and their psychopathology and is associated with suicide by firearms
Substance abuse for teens often co exists with other disorders most likely depression
Protective factors for suicide and substance overlap

Opiate abuse

Dramatic increase in opioid abuse including illicit Heroin and Fentanyl and prescribed painkillers such as OxyContin
Adolescents often believe that prescription medications are not dangerous
CDC reports a 4 fold increase in the number of prescriptions for opioids since 1999 and estimates are that since year 2000, 300,000 have died from opioids
Prevention

Raising awareness of the dangers in communities and families and providing support (CRAFT)
Reducing opioid prescriptions and treating chronic pain without opioids
Safe disposal of prescription medications
Medication assisted treatment such as Methadone and overdose antagonist Naloxone

Eating disorders

Eating disorders (ED)have the highest mortality of any mental illness
Long term struggles with ED and failed treatment result in hopelessness
Estimates are that Anorexia Nervosa increases the suicide risk 5 X while Bulimia Nervosa increases the risk 6X
Those with ED habituate to pain through starvation and complications of purging

Youth Experiencing Homelessness or Youth in Foster Care

1.5 million youth run away or are forced to leave their home each year in the U.S.
Suicide is the leading cause of death for homeless youth
More than 70% of homeless youth report experiencing depression and suicidal thoughts and approximately 50% report a history of suicide attempts
Homeless youth are 4x more likely to have attempted suicide in the past and 3x more likely to have attempted suicide in the last 12 months than non-homeless youth
LGBTQ+ homeless youth report higher rates of suicide attempts (62%) and are more than 2x as likely to die by suicide than heterosexual homeless youth

Children in foster care

More than 400,000 youth are in foster care on any given day in the U.S.
Youth involved in the child welfare system experience higher rates of mental illness and substance use and are at an elevated risk for suicidal behaviors
Foster care youth are 3x more likely to significantly consider suicide, 4x more likely to have made a suicide attempt in the past 12 months, and 5x more likely to be hospitalized following a suicide attempt when compared to non-foster care youth
Foster care youth are 3x to 5x more likely to die by suicide and up to 1/3 of all youth suicides occur among youth involved in the child welfare and juvenile justice systems

Bullies and victims

Children who have been bullied have reported a variety of behavioral, emotional and social problems.
Highest risk has been both bully/victim
Key factor is pre-existing psychopathology
Some gender differences in response to bullying
High risk groups include: Disabled, Race & Religion; LGBTQ+

Lesbian, gay, bisexual, transgender, questioning youth

Higher rates of family rejection & peer victimization

3X more likely to report suicidal ideation
8X more likely to have attempted suicide
6X more likely to have higher levels of depression
Compared to non-LGBTQ+ youth LGBTQ+ youth suicide attempts may be more serious

Depressed; Mental Illness

One in four youth
The majority does not receive services
Co-occurring disorders
Ignited by precipitating events
Of those who die by suicide, 90% have a mental illness and 60% of the time that mental illness is a mood disorder
Effective treatments include talk therapy and medications

NSSI

Maladaptive coping strategy
Generally assess at low risk for suicide
Episodic associated with emotional regulation
Repetitive NSSI associated with history of trauma, adverse childhood experiences (ACE)
Suicidal risk increases with number of years engaging in self injurious behaviors and number of methods
Treatment: Dialectical Behavior Therapy

Traumatized

One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior.
Trauma can impact school performance
Trauma can impact learning
Traumatized children can experience physical and emotional distress
Parents and teachers can help
Maladaptive coping:

Suicidal and/or homicidal ideation
Abuse of others or self (e.g., NSSI).
Extreme substance abuse and/or self-medication
Extreme rumination, hyper-vigilance and/or avoidance behavior
Taking excessive precautions

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Situational Crisis/Precipitating Events

Loss (Death, divorce, transience, romance, dignity)
Victimization/exposure to violence
School crisis (disciplinary, academic)
Family crisis (abuse, domestic violence, running away, argument with parents)
Exposure to suicide

There is often a situational crisis that may act as a spark to suicidal thoughts and behaviors.

There can be a profound or traumatic loss. The top three losses for kids are:

Loss of romance (the boyfriend/girlfriend break up!)
Loss caused by death of a loved one (it is most impactful when the death is by suicide. A suicide in the family can have an affect on the next 7 generations)
Loss of dignity as when a child or teen is bullied, cyber-bullied or humiliated in public.

The two crises most associated with school are:

Disciplinary crisis
Academic crisis

The two crises most associated with the home are:

Argument with parent
Witnessing or being the victim of domestic violence

Exposure to suicide: For every death by suicide, 135 people are exposed and up to a third will have this loss be a life changing event.

For some, this traumatic loss will precipitate their own thoughts of suicide.

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Four out of five youth say something, do something, write or draw something that comes to the attention of an adult or peer. If your child displays any of these suicide warning signs, please turn to the school immediately!

Parents/Families are “Gatekeepers”

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Warning Signs of Youth Suicide

Suicidal notes/texts/social media posts
Threats

Direct: “I want to die.” “I am going to kill myself.”
Indirect: “No one will miss me.” “The world will be better without me.”

Depression/Hopelessness

Loss of energy/lack of enthusiasm for life
Risk-taking behaviors such as drinking and driving, gunplay, alcohol and substance abuse

Plan/method/access
Giving away prized possessions/making final arrangements

Suicide notes

Not as common as you would think
Must now look for suicidal notes/comments on social media such as Facebook, Instagram or Twitter
May be a good time to mention the Facebook application when comments posted on walls are of concern.

Threats

Can be direct (i want to kill myself; i could just die) or indirect (the world would be a better place without me; nobody will miss me anyway)

Plan/method/access

The greater the planning, the greater the risk
Always ask “how would you kill yourself” to assess method and access to means of harm (gun)

Depression

Bipolar depression is the kind of depression most often associated with nssi and suicidal ideation and actions
Depression is a risk factor for suicide but hopelessness is a warning sign
Depression in children and adolescents can “look” like depression in adults (sad, irritable mood; fatigue; poor eating and sleeping; isolation) or it can include risk taking behaviors such as acting out; gun play; drinking & driving; alcohol and substance abuse

Making final arrangements

Giving away prized possessions such as articles of clothing, jewelry

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Intense feelings of being a burden
Isolation and a lack of belonging/connections
Sudden changes in behaviors, personality, friends

Changes to eating or sleeping habits

Death and suicidal themes in writings, readings, websites
Elementary school age children may:

Threaten to run into traffic
Jumping from high places
Cutting/scratching or marking the body

Warning Signs of Youth Suicide Cont’d

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Wanting the pain to end…

Suicide is seen by some teens as the ONLY way of ending their emotional pain…
They do not want to die and research says they are ambivalent up until the very last moment…
Suicide is Preventable!

If ANY of these warning signs are present, follow district procedure for referral and intervention.

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Intervention for parents
Do not be afraid to talk to students about suicide
KNOW the risk factors & warning signs
Offer to go with your child to the school or community mental health professional
Tighten the “Circle of Care” around your child
Remove all lethal means. Get the gun out of the house.

Let’s review the referral process…

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Listen to what your child says and does:

“I’m concerned about how you feel and cannot let anything happen to you…”
“I care about what happens to you and I need help in dealing with this…”
“Thank you for confiding in me. I do not want you to hurt yourself…”
“I’m on your side and we’ll get you help…”
“Thank you for trusting me…”
“I am so sorry this has happened to you.”
“I am here if you want to talk.”

What to say when you bring them to guidance…

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-Suicide is very complex but I do know that no one person, no one thing, is ever to blame.

-If anyone is bullying you at school, I am here to help you.

Protect by Maintaining Structure & Consistency

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Connect through interaction, activities and resources

“I will help you reach out to the family and I will go with you to the funeral if you want to go.”

Model & teach about normal reactions to traumatic events

“Everyone reacts to shocking news differently. Some may look numb, some angry, some may cry and some may even act silly.”
“If you are concerned about one of your friends, please tell me or another adult you trust to help you get help.”

Help them understand that it is ok to process thoughts about what happened with a trusted adult vs. with a peer which could cause rumors

When your child experiences a loss by suicide…

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Suicide is preventable: Prevention may be a matter of a caring person with the right knowledge being available in the right place at the right time. A parent is often this person.
ONE caring adult in the life of a child is the greatest protective factor there is!
There are treatments for all the risk factors of youth suicide, kids are resilient and can get better.
Everyone plays a role in suicide prevention. We rely on you for these timely referrals.

“You can be a Lifesaver”

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National Resources

Safe2Tell Anonymous Tip Line: (877) 542-7233

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National Resources

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Local Resources

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State Resources

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Adapted from: Lieberman & Poland (2018)

Erbacher, T. A., Singer, J. B., and Poland, S.(2015), Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention. New York: Routledge.

Lieberman, R., Poland, S., & Kornfeld, C. (2014). Best practices in suicide intervention. In A.Thomas & P. Harrison (Eds.), Best practices in school psychology. Bethesda, MD: National Association of School Psychologists.

References