Having Tough Conversations with Students About Suicide: What You Need to Know

1. Having Tough Conversations with Students About Suicide: What You Need to Know Laura Gallo, Ph.D, NCC, LPC Boise State University March 11, 2019

2. “Their pain in living is greater than the fear of dying”–Dr. Rudd

3. Purpose • This webinar will cover the most essential information school counselors need to know when working with children and adolescents who have suicidal ideation. Common myths, the importance of language, and connecting with students will be discussed within this hour long presentation.

4. Agenda • Big picture- Suicide as a public health issue, myths • Suicide prevention within schools- what does it look like? • Working with youth around the topic of suicide (developmental considerations, language, do’s and don'ts) • How do we intervene and the importance of connection • Resources • Question/answer time

5. definitions • Suicide attempt: a self-injurious act, committed with at least some intent to die as a result of the act. There does not have to be any injury or harm, just the potential for it. • Self-injurious behavior: when someone engages in the behavior, purely, 100%, for reasons other than to end one's life. What we think of as self-mutilation, that's to feel better, relieve internal pain, feel something, or what we call affecting external circumstances. • Interrupted attempt: when a person starts to take steps to end their life, but someone, or something, stops them • Aborted attempt: when a person starts to take steps to end their life but they stop themselves • Preparatory behavior: any other behavior with suicidal intent: collecting or buying pills, purchasing a gun, writing a will or suicide note.

6. Statistics for Youth (ages 15-24) • Suicide is the 2nd leading cause of death for youth with a rate of 12.5 per 100,000 • One youth completes suicide every 1 hour and 25 minutes • 5,723 youth completed suicide in 2016 • Of all deaths, it accounts for 13% (accidents are highest) • 4 out of 5 teens who attempt suicide have given clear warning signs •  96% of self-injury is not related to suicide but they can be acquiring the pattern of self-injury that can later lead to suicide • Impulsivity is NOT an excuse to miss warning signs (AAS, 2017)

7. Meanwhile, back in Iowa . . . . • https://www.desmoinesregister.com/story/news/2019/03/06/youth-survey-iowa-2018-suicide-binge-drinking-iowa-department-public-health-vaping-e-cigarette/3081578002/ • 1 in 10 students reported they had a plan for suicide, 1 in 20 reported they attempted- increase by 53% between 2012-2018 (2018 Youth Survey as reported in Des Moines Register)

8. Myths surrounding suicide • Talking about suicide with adolescents increases suicide risk • Most adolescents who attempt suicide wish to die • Adolescents only use the word “suicide” for attention • Every adolescent who dies by suicide is depressed • Current prevention programs are sufficient to prevent teen suicide (Granello & Granello, 2007, p. 6-7)

9. 7 Evidence-Based Programs identified by SAMHSA • CASE (Coping and Support Training) • LEADS: For Youth • Lifelines • *Kognito At-Risk for High School Educators • *SOS (Signs of Suicide) • *Sources of Strength • *QPR *programs I am familiar with in schools More listed on pages 54-55

10. Prevention • Upstream prevention​ • Promote student well-being​ • School climate​ • belongingness​ • Schoolwide prevention​ • Train gatekeepers, train students, screening only with trained personnel • ​Important to send strong message to adolescents- HELP is available and HELP-SEEKING is a desirable response to a serious issue • Create a culture where adults have positive attitudes regarding help-seeking behaviors- research shows this has decreased suicide rates • Teaching help-seeking behavior BEFORE a crisis • Intervention best practice planning​ • Train entire school community, involve emergency personnel​ • Messaging is everything! Positive opposites

11. Screenings • The purpose is to identify students at risk for suicide, suicidal behaviors, and suicidal ideation- results indicate who may need further intervention (interview) • Individual vs. Universal • *Be careful- follow procedures put in place, see p. 162-164 for steps • What are the concerns with universal screenings?

12. Working with parents • In almost all cases, when working with minors, parents/guardians would need to be notified if the child is at risk for suicide • The school/agency should have a protocol in place that outlines how/when to notify parents/guardians • Consider what to do if parent is not open to seeking help for their child *Be sure to support parents as well, they may be experiencing a wide range of emotions and need assistance in finding resources for their child. Also, the counselor should always DOCUMENT what has been done and when contacts were made!

13. A Comprehensive Approach • Promote connectedness among all students • Identify students who may be at risk- get them help • Be prepared to respond if a suicide death occurs • https://www.sprc.org/settings/schools

14. Intervention • How do we know when to intervene? • What does it even look like? • What if I do it wrong? • What is the most successful intervention?

15. Interpersonal-Psychological Theory of Suicide by Joiner • Perceived burdensomeness​ • Thwarted belongingness​ • Fearlessness about pain, injury and death (acquired ability for self-harm)

16. 5 Most Basic Warning Signs(according to Dr. Rudd) • Anxiety (not recognized) • Agitation (different than anxiety) • Hopelessness • Sleep disturbance (especially in adolescents) • Perceived burdensomeness

17. Connecting with the student & Asking about suicide • Building rapport • How do we know if the behavior is suicidal? • Listen for INTENT • Assess "degree of preparation" • What have they planned? This tells us a lot

18. Adolescent considerations • Emphasize the difference between “thinking about it” and “working toward it” (also fluid nature of intent) • 70% of suicide attempts are made within 30 minutes of the decision (impulsiveness) but not the contemplation- this can last much longer • Recognize that the weapon/means is what kills them (not the incident of bullying, a breakup, etc) • 33% of children/adolescents kill themselves on the same day of the crisis (2014) • Work on means restriction with parents- #1 thing we can do= TRIGGER LOCKS • **Key to changing suicidal thinking is EMOTIONAL REGULATION (how to soothe yourself and how to deal with others better) (Rudd, 2017)

19. Importance of Hope • “A person who is hopeful is a person who wishes to live” –F.J. Hanna • Importance of developing close relationships and sustaining a positive vision for the future • Hope provides a positive outlook on life- works as a buffer against suicide • Hope can be built and maintained through the experience of having received help in the past and realizing that help is presently available • Help and hope should come from multiple sources (Roswarski & Dunn, 2009)

20. Protective factors • Family support (and acceptance *LGBTQ) • Connections to family and friends who care about them and to school • Sense of safety (safe schools) • Reduced access to firearms • Academic achievement • Self-esteem

21. Talking about suicide in social media • Be wary of using social media platforms as these can elevate contagion risks associated with unsafe media discussions about suicide • Don’t use Twitter or Facebook to announce news of suicide deaths • Don’t give details of a suicide death (means, etc) or the ages/personal details of the victim on Twitter or Facebook • Don’t re-post problematic mainstream media headlines (for example, “Student, 15, Commits Suicide Over Bullying”) on Facebook or Twitter

22. Do’s and Don’t’s • Adults need to stress that suicide is rare, we don't want to normalize the behavior (ok to normalize the thinking and sadness- but not behavior)​ • Be careful about using stats, they will latch onto it​ • Do not talk about means, do not share stories that are sad, shocking, etc​ • Remember children and adolescents do have strength and resilience​ • Let them know there are trusted adults they can talk to, no code of silence​ • Do know the warning signs​ • Do promote the hotline (Kane, 2016)

23. Messaging • http://suicidepreventionmessaging.org/

24. Final thoughts • The thought of young people attempting and dying by suicide is scary, but we CAN make a difference for many- BE BRAVE

25. Resources • Your Iowa Life- call 855-581-1111 or text 855-895-8398 or their website at yourlifeiowa.org • National Suicide Prevention Hotline: 800-273-TALK (8255) • Preventing Suicide: A Toolkit for High Schools (SAMHSA)- you can order a free copy online • NAMI: https://www.nami.org/ • AFSP: https://afsp.org/ • AAS: http://www.suicidology.org/ • The Trevor Project: http://www.thetrevorproject.org *for LGBTQ youth