Suicide Awareness & Prevention

1. Suicide Awareness & Prevention A Workshop for Faculty & Staff Presented by: Dr. Melanie Morgan

2. There is a silent epidemic sweeping through our nation that claims and average of approximately 100+ young lives each week. It knows no social, racial, or economic barriers. This silent epidemic is youth suicide!According to the CDC and Prevention’s 2011 Youth Risk Behavioral Survey over 1 out of every 13 young people in our nation attempted suicide in the previous 12 months. The Jason Foundation (2014).

3. National Data • Average of 1 person every 13.7 minutes killed themselves • Average of 1 old person every 1 hour and 28 minutes killed themselves • Average of 1 young person every 1 hour and 54 minutes killed themselves. (If the 274 suicides below age 15 are included, 1 young person every 1 hour and 48 minutes) • 10th ranking cause of death in U.S. • 3.7 male deaths by suicide for each female death by suicide • Suicide ranks 10th as a cause of death; Homicide ranks 16th • 959,100 annual attempts in U.S. (using 25:1 ratio); 2010 SAMHSA study: 1.1 million adults (18 and up) • 3 female attempts for each male attempt • Based on the 796,672 suicides from 1986 through 2010 and using 6 survivors per suicide, estimated that the number of survivors of suicides in the U.S. is 4.78 million (1 of every 65 Americans in 2010); number grew by at least 230,184 in 2010 • If there is a suicide every 13.7 minutes, then there are at least 6 new survivors every 13.7 minutes as well The Suicide and Crisis Center of North Texas (2011a)

4. Local State Data: Texas Figure 6 shows the state rate from 2006-2010 for 15-19 year olds in comparison to the US rate for the same age group. Children’s Safety Network (2013)

5. Local State Data: Texas Children’s Safety Network (2013)

6. Local State Data: Texas Children’s Safety Network (2013)

7. Local State Data: Texas Children’s Safety Network (2013)

8. Local State Data: Texas • In the last 10 years, there have been 2,928 suicides in Texas for ages 15-24 and 166 for ages 5-14. Suicide is the leading cause of death for 15-19 year olds • Almost as many teens die by suicide as those who die from all natural causes combined • For Texas high school students in a 12 month period: • 16% think seriously of suicide • 9% attempt suicide • 3% make a suicide attempt that requires medical attention Children’s Safety Network (2013); Texas Department of State Health Services (2014)

9. Local City Data: San Antonio most recent available data is 2009 Bexar County Youth (up to age 24) San Antonio Metropolitan Health District (2009)

10. Local City Data: San Antonio most recent available data is 2009 • Bexar County recorded 157 suicide deaths in 2009 of which 85% were males • Suicide was the ninth leading cause of death in Bexar County and the fifth leading cause of premature death • The younger population of suicides (5-34) had a higher percentage of Hispanic suicides compared to older population (35-64) which had much higher White (not Hispanic) suicides San Antonio Metropolitan Health District (2009)

11. Legality & Ethics

12. The Family Educational Rights and Privacy Act (FERPA) prevents the disclosure of personally identifiable information from a student’s education record without the consent of a parent of eligible student unless an exception to the law’s general consent requirement applies. In cases of health and safety emergencies, appropriate officials may be contacted prior to consent. U.S. Department of Education. (2014)

13. Texas State Statutes Texas Family Code § 32.004 outlines that (a) a minor may consent to counseling for (1) suicide prevention and that (b) …a certified counselor… having reasonable grounds to believe that a child…is contemplating suicide may (1) counsel the child without the consent of the child’s parents Texas State Legislative Code (1995)

14. Ethical Guidelines • Assessment • Duty to Warn Parents • Duty to Provide Referrals • Follow up and support the family National Association of School Psychologists (2001)

15. Facts & Factors

16. Healing is a matter of time, but it is sometimes also a matter of opportunity. Hippocrates We must provide that opportunity!

17. Suicide Facts Suicide touches everyone – all ages and incomes; all racial, ethnic, and religious groups; and in all parts of the country. The emotional toll on those left behind remains long after the event. Suicide is the third leading cause of death among teenagers (CDC, 2010). In addition, each year: • About 4,700 young people ages 14-24 die by suicide (CDC, 2010) • Approximately 1 out of 6 high school students seriously consider attempting suicide (CDC, 2012) • 1 out of 13 high school students attempt suicide one or more times (CDC, 2012) However, there is help and hope when individuals, schools, and communities join forces to address suicide as a preventable public health problem. Suicide Prevention Resource Center (2012)

18. Risk Factors Risk factors vary with age, gender, or ethnic group. They may occur in combination or change over time. Some important risk factors are: • Depression or other mental disorders • Substance abuse (often in combination with other mental disorders) • Easy access to firearms • Incarceration • Prior suicide attempt • History of suicide in the family • History of abuse in the family • Exposure to suicidal behaviors of others National Institute of Mental Health (n.d.)

19. Identification Identifying Students Who May Be At Risk for Suicide

20. Be alert to problems that increase suicide risk You may notice problems facing your students that may put them at risk for suicide. There are a large number of risk factors for suicide. Some of the most significant ones are: • Prior suicide attempt(s) • Alcohol and drug abuse • Mood and anxiety disorders, e.g., depression, posttraumatic stress disorder (PTSD) • Access to a means to kill oneself, i.e., lethal means Suicide risk is usually greater among people with more than one risk factor. For individuals who are already at risk, a “triggering” event causing shame or despair may make them more likely to attempt suicide. These events may include problems in school (academic and/or discipline), family problems or abuse, relationship problems or break-ups, bullying, and legal difficulties. Even though most people with risk factors will not attempt suicide, they should be evaluated by a professional. Suicide Prevention Resource Center (2012)

21. Look for signs of immediate risk for suicide Some behaviors may indicate a person is at immediate risk for suicide and should prompt you to take action right away: • Talking about wanting to die or to kill oneself • Looking for a way to kill oneself, such as searching online or obtaining a gun • Talking about feeling hopeless or having no reason to live Other behaviors may also indicate a serious risk—especially if the behavior is new; has increased; and/or seems related to a painful event, loss, or change: • Sleeping too little or too much • Withdrawing or feeling isolated • Showing rage or talking about seeking revenge • Displaying extreme mood swings • 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; behaving recklessly Suicide Prevention Resource Center (2012)

22. Let’s Play a Game of Truth or Myth

23. Truth or Myth? People who talk about suicide are just trying to get attention. Myth! People who die by suicide usually talk about it first. They are in pain and oftentimes reach out for help because they do not know what to do and have lost hope. Always take talk about suicide seriously. Always. People who talk about wanting t die by suicide do not try to kill themselves. Myth! People who talk about wanting to die by suicide oftentimes kill themselves. Suicide always occurs without any warnings. Myth! There are almost always warning signs. Suicide.org (n.d.)

24. Truth or Myth? Once people decide to die by suicide, there is nothing you can do to stop them. Myth! Suicide can be prevented. Most people who are suicidal do not want to die; they just want to stop their pain. Suicide only strikes people of a certain gender, race, financial status, age, etc. Myth! Suicide can strike anyone. People who attempt suicide and survive will not attempt suicide again. Myth! People who attempt suicide and survive will oftentimes make additional attempts. Suicide.org (n.d.)

25. Truth or Myth? People who attempt suicide are crazy. Myth! No. They are in pain and probably have a chemical imbalance in their brain. Anyone could attempt suicide. People who attempt suicide are weak. Myth! No. They are in pain and probably have a chemical imbalance in their brain. Many people who are very “strong” die by suicide. People who talk about suicide are trying to manipulate others. Myth! People who talk about suicide are in pain and need help. And telling them that they “just want something” or “are trying to manipulate” is both insensitive and ignorant. People often talk about suicide before dying by suicide. Always take talk about suicide seriously. Always. Suicide.org (n.d.)

26. Truth or Myth? When people become suicidal, they will always be suicidal. Myth! Most people are suicidal for a limited period of time. However, suicidal feelings an reoccur. People who are suicidal definitely want to die. Myth! The vast majority of people who are suicidal do not want to die. They are in pain and they want to stop the pain. You should never ask people who are suicidal if they are thinking about suicide or if they have thought about a method, because just talking about it will give them the idea. Myth! Asking people if they are thinking about suicide does not give them the idea for suicide. It is important to talk about suicide with people who are suicidal because you will learn more about their mindset and intentions and allow the to diffuse some of the tension that is causing their suicidal feelings. Suicide.org (n.d.)

27. Truth or Myth? Young people never think about suicide; they have their entire life ahead of them. Myth! Suicide is the 3rd leading cause of death for young people aged 15-24. Sometimes children under 10 die by suicide. There is little correlation between alcohol or drug abuse and suicide. Myth! Oftentimes people who die by suicide are under the influence of alcohol or drugs. People who are suicidal do not seek help. Myth! Many people who are suicidal reach out for help. Suicide.org (n.d.)

28. Our sorrows and wounds are healed only when we touch them with compassion. Buddha

29. Ways to be Helpful • Talk with the school’s counselor about your concerns. S/he may decide to obtain information about the student from other school staff to determine how best to help the student. • Reach out to the student and ask how he or she is doing. Listen without judging. You could mention changes you have noticed in his or her behavior and that you are concerned. If the student is open to talking further with someone, suggest that he or she see the school counselor. • Continue to stay in contact with the student and pat attention to how he or she is doing. Also, stay in touch with the counselor as needed. Suicide Prevention Resource Center (2012)

30. Protocol What To Do

31. Key Steps • Understand why suicide prevention fits with your role as a teacher • Identify students who may be at risk for suicide • Respond to students who may be at risk for suicide • Be prepared to respond to a suicide death • Consider becoming involved in school wide suicide prevention Suicide Prevention Resource Center (2012)

32. If you do not hear the information first hand… • Talk with the student who may be at risk • Listen and remain calm. • Assess the risk for potential harm. • Contact parent or guardian • Follow up with necessary referrals Suicide Prevention Resource Center (2012)

33. If you hear the information first hand… • Stay calm. • Talk and ask questions. • Do not leave the student alone. • Notify proper school personnel [counselor, nurse, and administration] of the incident exactly as you heard it • Inform parent or guardian • Provide referral information • Document your actions and communication Suicide Prevention Resource Center (2012)

34. Prevention and Response • Individual counseling • Group counseling • Counseling referral • Collaboration with administrators • Faculty and staff training • Educate Parents • Educate Students • Support School Safety and Reduce Bullying • Support Gun Safety Programs American Foundation for Suicide Prevention (2009)

35. Although the world is full of suffering, it is also full of the overcoming of it. Helen Keller With resources we can help with that!

36. Resources For Referral, Help, and Information

37. Download the app now so you have it! The Lifeline is a 24-hour toll-free phone line for people in suicidal crisis or emotional distress.

38. San Antonio Area Resources The Center for Health Care Services 303 IH 10 West San Antonio, Texas 78201 800-316-9241 or 210-223-7233 Main Phone: 210-731-1300 Website: http://www.chcsbc.org Serves Bexar County Camino Real Community Services 19965 FM 3175 N. Lytle, Texas 78052 800-543-5750 Main Phone: 210-357-0300 Website: http://www.caminorealcs.org Serves Atascosa, Dimmit, Frio, La Salle, Karnes, Maverick, McMullen, Wilson and Zavala Counties Texas Department of State Health Services (2014)

39. After a Suicide: A Toolkit for Schools http://www.sprc.org/library_resources/items/after-suicide-toolkit-schools • American Association of Suicidologyhttp://www.suicidology.org/ • American Foundation for Suicide Prevention http://www.afsp.org/ • Centers for Disease Control Suicide Resources http://www.cdc.gov/ncipc/factsheets/suifacts.htm • Best Practices Registry for Suicide Prevention http://www.sprc.org/bpr • Los Angeles County Youth Suicide Prevention Project http://preventsuicide.lacoe.edu/index.php • National Depressive and Manic-Depressive Association http://www.dbsalliance.org/ • National Mental Health Association http://www.nmha.org/ • National Suicide Prevention Lifeline http://www.suicidepreventionlifeline.org/ • NIMH Suicide Research Consortium http://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml • Preventing Suicide: A Toolkit for High Schools http://store.samhsa.gov/product/Preventing-Suicide-A-Toolkit-for-High-Schools/SMA12-4669?WT • SA/VE Suicide Awareness/Voices of Education http://www.save.org/ • Society for the Prevention of Teen Suicide http://www.sptsusa.org • Suicide Prevention Advocacy Network (SPAN) http://www.spanusa.org/ The Suicide and Crisis Center of North Texas (2011); Suicide Prevention Resource Center (2012)

40. Suicide Prevention among Lesbian, Gay, Bisexual, and Transgender Youth: Expanding the Frame and Broadening Our Approaches http://www.sprc.org/training-institute/r2p-webinars/suicide-prevention-among-lesbian-gay-bisexual-and-transgender-youth- • Suicide Prevention among LGBT Youth: A Workshop for Professionals Who Serve Youth http://www.sprc.org/training-institute/lgbt-youth-workshop • Suicide Warning Signs (wallet card) http://www.suicidepreventionlifeline.org/getinvolved/materials.aspx • Surgeon General’s Call to Action to Prevent Suicide 1999 http://www.surgeongeneral.gov/library/calltoaction/calltoaction.htm • Texas statutes regarding suicide http://www.sccenter.org/pdf/Texas_laws_suicide.pdf • Texas Suicide Prevention http://www.texassuicideprevention.org/ • The Trevor Project http://www.thetrevorproject.org • Youth Suicide Prevention, Intervention, and Postvention Guidelines: A Resource for School Personnel http://www.maine.gov/suicide/docs/Guidelines%2010-2009--w%20discl.pdf • Youth Suicide Prevention Program http://www.yspp.org • Youth Suicide Prevention School-Based Guide http://theguide.fmhi.usf.edu/ • In addition to these resources, the School section of the Suicide Prevention Resource Center online library has many other materials. Go to • http://www.sprc.org/search/library/School?filters=type%3Alibrary_resource The Suicide and Crisis Center of North Texas (2011); Suicide Prevention Resource Center (2012)

41. This Presentation

42. References American Foundation for Suicide Prevention (2009). More than sad: suicide prevention education for teachers and other school personnel. Retrieved from http://www.morethansad.org/programmanual.pdf Centers for Disease Control and Prevention.(2014). Suicide prevention: youth suicide. Retrieved from http://www.cdc.gov/violenceprevention/pub/youth_suicide.html Children’s Safety Network. (2013). Texas 2013 state fact sheet. Retrieved from http://www.childrenssafetynetwork.org/state/texas/2013 Department of Education (ED). (2010). Family educational right and privacy act. Retrieved from http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html National Association of School Psychologists (NASP). (2014). Preventing youth suicide – Tips for parents and educators. Retrieved from http://www.nasponline.org/resources/crisis_safety/suicideprevention.aspx National Association of School Psychologists (NASP). (2001). Times of tragedy: Preventing suicide in troubled children and youth part II. Retrieved from http://www.nasponline.org/resources/crisis_safety/suicidept2_general.aspx National Institute of Mental Health (NIMH). (n.d.). Suicide: A major preventable mental health problem. Retrieved from http://www.nimh.nih.gov/health/publications/suicide-a-majorpreventable-mental-health-problem-fact-sheet/index.shtml San Antonio Metropolitan Health District. (2009). Bexar county mortality 2009: Leading cause of death and mortality trends by age, race, and ethnicity 2001-2009. Retrieved from https://www.sanantonio.gov/Portals/0/Files/health/News/BexarCountyMortality-2009.pdf Suicide.org (n.d.) Suicide myths. Retrieved from http://www.suicide.org/suicide-myths.html

43. References Suicide and Crisis Center of North Texas (2011a). Suicide is a leading killer in America. Retrieved from http://www.sccenter.org/facts.html Suicide and Crisis Center of North Texas (2011b). Texas statutes regarding suicide. Retrieved from http://www.sccenter.org/pdf/Texas_laws_suicide.pdf Suicide Prevention Resource Center. (SPRC) (2012). The role of high school mental health providers in preventing suicide. Retrieved from http://www.sprc.org/sites/sprc.org/files/SchoolMentalHealth.pdf Suicide Prevention Resource Center. (SPRC) (2012). The role of high school teachers in preventing suicide. Retrieved from http://www.sprc.org/sites/sprc.org/files/Teachers.pdf Texas Department of State Health Services. (2014). Mental health crisis hotlines. Retrieved from https://www.dshs.state.tx.us/mhsa-crisishotline/ Texas State Legislative Code. ch. 32.Family code. Child in relation to the family. Limitations of minority. Consent to treatment of child by non-parent or child. Consent to medical, dental psychological, and surgical treatment.  § 004. Consent to counseling. April 20, 1995. The Jason Foundation. (2014). The parent resource program. Retrieved from http://jasonfoundation.com/prp/ United States Department of Education (USDE). (2014). Family educational rights and privacy act (FERPA). Retrieved from http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html