Suicide Prevention For Schools

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Suicide Prevention For Schools - Part II

From the World Health Organiztion

HOW TO IDENTIFY STUDENTS IN DISTRESS AND AT POSSIBLE RISK OF SUICIDE

Identification of distress
Any sudden or dramatic change affecting a child’s or adolescent’s performance, attendance or behaviour should be taken seriously,such as:

• lack of interest in usual activities;
• an overall decline in grades;
• decrease in effort;
• misconduct in the classroom;
• unexplained or repeated absence or truancy;
• excessive tobacco smoking or drinking, or drug (including cannabis) misuse;
• incidents leading to police involvement and student violence.

These factors help to identify school students at risk of mental and social distress who may have thoughts of suicide that ultimately lead to suicidal behavior. If any of these signs are identified by a teacher or school counselor, the school team should be alerted and arrangements should be made to carry out a thorough evaluation of the student, since they usually indicate severe distress and the outcome may, in some cases, be suicidal behavior.

Assessment of suicide risk

When assessing suicide risk, school staff should be aware that problems are always multidimensional.

Previous suicide attempts
A history of previous suicide attempts is one of the most significant risk factors. Young people in distress tend to repeat their acts.

Depression
Another major risk factor is depression. The diagnosis of depression should be made by a physician or child/adolescent psychiatrist, but teachers and other school staff should be aware of the variety of symptoms that form part of depressive illness.

The difficulty of assessing depression is linked to the fact that the natural transitional stages of adolescence share some features with depression.

Adolescence is a normal state, and during its course such features as low self-esteem, despondency, concentration problems, fatigue and sleep disturbances are common. These are also common features of depressive illness, but there is no cause for alarm unless they are lasting and increasingly severe. Compared with depressed adults, the young tend to act out, eat and sleep more.

Depressive thoughts may be present normally in adolescence and reflect the normal development process, when the young person is preoccupied with existential issues. The intensity of suicidal thoughts, their depth and duration, the context in which they arise and the impossibility of distracting a child or adolescent from these thoughts (i.e. their persistence) are what distinguishes a healthy young person from one in the throes of a suicidal crisis.

Risk situations

Another important task is to identify environmental situations and negative life events, as outlined previously, that activate suicidal thoughts and thus increase suicide risk. HOW SHOULD SUICIDAL STUDENTS BE MANAGED AT SCHOOL?

Recognizing a young person in distress, who needs help, is not usually much of a problem. Knowing how to react and respond to suicidal children and adolescents is much more difficult.

Some school staff have learned how to treat distressed and suicidal students with sensitivity and respect, while others do not. The latter group’s skills should be improved.

The balance that must be struck in the contact with a suicidal student is one between distance and closeness, and between empathy and respect.

The recognition and management of suicidal crises in students may give rise to conflict in teachers and other school staff since they lack the specific skills required, are short of time, or fear facing their own psychological problems.

General prevention: before any suicidal act takes place

The most important aspect of any suicide prevention is early recognition of children and adolescents in distress and/or at increased risk of suicide. To achieve this goal, particular emphasis should be laid on the situation of the school staff and students concerned, by the means described below. Many experts share the view that it is unwise to teach young people about suicide explicitly. Rather, they recommend that issues relating to suicide are replaced by a positive mental health approach.

Strengthening the mental health of schoolteachers and other school staff

First of all, it is essential to secure the well-being and balance of teachers and other school staff. For them, the workplace may be rejecting, aggressive and sometimes even violent.

Therefore they need information material that enhances their understanding and proposes adequate reactions to their own, students’ and colleagues’ mental strain and possible mental illness. They should also have access to support and, if necessary, treatment.

Strengthening students’ self-esteem

Positive self-esteem protects children and adolescents against mental distress and despondency, and enables them to cope adequately with difficult and stressful life situations.

To foster positive self-esteem in children and adolescents a variety of techniques can be used. Some recommended approaches follow:

• Positive life experiences that will help to forge a positive identity26 in the young should be accentuated. Positive past experiences increase young people‘s chances of greater future self-confidence.
• Children and adolescents should not be constantly pressured to do more and better.
• It is not enough for adults to say they love the child; the child must feel loved. There is a big difference between being loved and feeling loved.
• Children should not only be accepted, but also cherished, as they are. They must feel special just because they exist.

Whereas sympathy impedes self-esteem, empathy fosters it, because judgement is set aside. Autonomy and mastery are building-blocks in the development of positive self-esteem in, early childhood.

Children’s and adolescents’ achievement of self-esteem is dependent on their development of physical, social and vocational skills. For high self-esteem, the teenager needs to establish final independence from family and age mates; be able to relate to the opposite sex; prepare for an occupation for self-support; and establish a workable and meaningful philosophy of life.

Introducing training in life skills, first by visiting experts and later as part of the regular curriculum, is an effective strategy. The programme should convey knowledge to peers on how to be supportive and, if necessary, seek adult help.

The education system should also enhance the development and consolidation of every student’s sense of identity.

Promoting the stability and continuity of students’ schooling is another important aim.
Promoting emotional expression

Children and adolescents should be taught to take their own feelings seriously and encouraged to confide in parents and other adults, such as teachers, school doctors or nurses, friends, sport coaches, and religious advisers.

Preventing bullying and violence at school

Specific skills should be available in the education system to prevent bullying and violence in and around the school premises in order to create a safe environment free of intolerance.

Providing information about care services

The availability of specific services should be ensured by widely publicizing the telephone numbers of, for example, crisis and emergency helplines and psychiatric emergency numbers, and making them accessible to young people.

Intervention: when a suicide risk is identified

In most cases, children and adolescents in distress and/or at risk of suicidal behaviour also experience communication problems. Consequently, it is important to establish a dialogue with a distressed and/or suicidal young person.

Communication

The first step in suicide prevention is invariably a trustful communication. During the development of the suicidal process, mutual communication between suicidal young people and those around them is crucially important. Lack of communication and the broken network that ensues result in:

• Silence and increased tension in the relationship. The adult’s fear of provoking the child or adolescent into committing a suicidal act by discussing his or her suicidal thoughts and messages is often the reason for the silence and absence of dialogue.
• Obvious ambivalence. Understandably, adults’ confrontation with a child or adolescent suicidal communication brings their own psychic conflicts to the fore. The psychological strain of an encounter with a distressed and/or suicidal child or adolescent is usually very heavy, and involves a wide range of emotional reactions. In some cases, the unsolved emotional problems of adults who are in contact with suicidal children and adolescents may come to the surface. Such problems may be accentuated among school staff, whose ambivalence - wanting, but simultaneously being unwilling or unable, to help the suicidal student - may result in avoidance of dialogue.
• Direct or indirect aggression. Adults’ discomfort is sometimes so great that their ultimate reaction to the child or adolescent who is in distress or suicidal is one of verbal or nonverbal aggression.
• It is important to understand that the teacher is not alone in this communication process, and learning how to achieve good communication is therefore fundamental. The dialogue should be created in and adapted to each situation. Dialogue implies, first and foremost, recognition of children’s and adolescents’ identity and also their need for help. Children and adolescents in distress or at risk of suicide are often hypersensitive to other people’s style of communication most of the time. This is because they have often lacked trustful relationships with their families and peers during their upbringing, and so have experienced an absence of interest, respect or even love. The suicidal student’s hypersensitivity is apparent in verbal and non-verbal communication alike. Here, body language plays as large a role as verbal communication. However, adults should not be discouraged by distressed and/or suicidal children’s or adolescents’ reluctance to speak to them. Instead, they should remember that this attitude of avoidance is often a sign of distrust of adults.

Suicidal children and adolescents also display marked ambivalence about whether to accept or reject help that is offered, and about whether to live or die. This ambivalence has evident repercussions on the suicidal young person’s behaviour, which can show rapid changes from help-seeking to rejection and may easily be misinterpreted by others.

Improving school staff’s skills This may be done by means of special training courses aimed at improving communication between distressed and/or suicidal students and their teachers, and enhancing awareness and understanding of suicide risk. Training all school staff in the capacity to talk among themselves and with the students about life and death issues, improving their skills in identifying distress, depression and suicidal behaviour, and increasing their knowledge about available support are crucial means of suicide prevention.

Clear goals and precise limits as defined in manuals on suicide prevention are important tools in this work.

Referral to professionals
A prompt, authoritative and decisive intervention, i.e. taking the suicidal young person to a general practitioner, a child psychiatrist or an emergency department, can be life-saving.

To be effective, youth health services need to be perceived as approachable, attractive and non-stigmatizing. Distressed and/or suicidal students should be actively and personally referred by school staff, and received by a team composed of doctors, nurses, social workers and legal representatives whose task is to protect the child’s rights. This active transfer of the student to the health care system prevents her or him from dropping out during the referral process, which might happen if the referral is conducted only by correspondence.

Removing means of suicide from distressed and suicidal children’s and adolescents’ proximity

Various forms of supervision and removal or locking-up of dangerous medicines, guns, firearms, pesticides, explosives, knives, and so forth in schools, parental homes and other premises are very important life-saving measures. Since these measures alone are not enough to prevent suicide in the long run, psychological support should be offered at the same time.

When suicide has been attempted or heappened

Informing school staff and schoolmates

Schools need to have emergency plans on how to inform school staff, especially teachers, and also fellow pupils and parents, when suicide has been attempted or committed at school, the aim being to prevent a cluster of suicides. The contagion effect results from suicidal children’s and adolescents’ tendency to identify with destructive solutions adopted by people who have attempted or committed suicide. Recommendations on how to manage and prevent suicide clusters, developed and promulgated by the US Centers for Disease Control in 1994 are now in wide use.

It is important to identify all suicidal students, both in the same class and in others. A suicide cluster, however, may involve not just children or adolescents who know one another: even young people who are far removed from or entirely unknown to suicide victims may identify with their behaviour and resort to suicide as a result. Schoolmates, school staff and parents should be properly informed about a student’s suicide or attempted suicide and the distress caused by such an act should be worked through.

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