Suicide Prevention, Intervention, and
Postvention for Educators
Southeast Nebraska Suicide Prevention Project
and
Robin Zagurski, LCSW
University of Nebraska Medical Center
Supported by a grant from the Nebraska Healthcare Cash Fund
Objectives for Educators
Know symptoms of depression in adolescents
Understand that suicide is a public health
problem
Identify ways to protect yourself and others
from suicide
Identify suicide risk factors
Know the red light warning signs for suicide
risk
Are comfortable offering help to someone at
risk for suicide
Have resources for postvention after a student
suicide
Common terms used in this
presentation
Suicide – Intentionally taking one’s own life
Suicide act or gesture – Actions to deliberately
injure oneself or attempt to injure oneself without
resulting in death.
Suicide Behavior – Thoughts, plans, or actions
which if implemented could result in death
Postvention - An intervention after a suicide for
the students, faculty and friends designed to
facilitate grieving.
Questions
Concerns
Worries
Beliefs
Teen Depression
Teenagers,
especially young
teens, may exhibit
several symptoms
of depression and
yet be unaware
that they are
suffering from
depression.
Adolescent Depression
Extreme sensitivity to rejection or failure
Low self-esteem and feelings of guilt
Frequent complaints of physical illnesses
such as headaches and stomachaches
Frequent absences from school or poor
performance in school
Threats or attempts to run away from home
Major changes in eating or sleeping patterns
(American Academy of Child and Adolescent Psychiatry, 8/98)
Adolescent Depression
Sad, blue, irritable and/or complains
that nothing is fun anymore
Trouble sleeping, low energy, poor
appetite and trouble concentrating
Socially withdrawn or performs more
poorly in school
Can be suicidal
National Institute of Mental Health, Treatment of Adolescent Depression
Study (TADS)
Adolescent Anxiety
Excessive worries
Worries about school performance
Difficulty making friends
Isolative
Perfectionistic
Rigid thinking and behavior patterns
Phobias
Suicidal Ideation
(Hoberman and Garfinkel 1988)
In a study of 229 completed youth suicides:
62% had made a suicidal statement
45% had consumed alcohol within 12 hours
of killing themselves
76% had shown a decline in academic
performance in the past year
Teen Suicide in the U.S.
There are 25 suicide attempts for every
completion for our country as a whole
There are between 100-200 teen attempts before
completing suicide
Girls attempt more often (3:1)
Boys complete suicide more often (4:1)
Every year approximately 2,000 teens suicide
Journal of American Academy of Child and Adolescent Psychiatry,
Practice Parameters, 2002
Although suicide is the 11th leading cause of death for
the overall population, it is the 3rd leading cause of death
for 15-24 year olds.
Nebraska Teen Suicide Statistics
2001
In Nebraska:
2 children between the ages of 10-
14 killed themselves
17 teens between the ages of 15-19
killed themselves
13 of those suicides were by
gunshot
Cultural Factors
African Americans currently have a
lower rate of suicide than whites,
The suicide rate of African-American
adolescent and young adult males has
been rising rapidly.
Native American and Alaskan Native
youth have a very high rate of suicide.
Attempted suicide rates of Hispanic
youth are greater than those of white
and African-American youth.
Journal of American Academy of Child and Adolescent Psychiatry,
Practice Parameters, 2002
Gay and Lesbian Youth
There is no evidence gay or lesbian youth
commit suicide more often than
heterosexual teens.
However, there is strong evidence that gay,
lesbian and bisexual youths of both sexes
are more likely to experience suicidal
ideation and attempt suicide.
Alcohol and Suicide
Alcoholics have a suicide rate
50 times higher than the
general population
Alcohol dependent persons
make up 25% of all suicides
18% of alcoholics eventually
complete suicide
States with the most restrictive
policies toward alcohol have
the lowest suicide rates (Lester,
1993)
Self-Injury vs. Suicide
Self-injury is an attempt to alter one’s
mood by inflicting physical harm on
oneself:
Carving
Burning
Scratching
Branding
Hitting
Protection Against Suicide
Green Light…Good to Go!
Getting help for mental, physical and substance
abuse disorders - Especially depression
Restricted access to highly lethal methods of
suicide – especially firearms
An established relationship with a doctor,
clergy, teacher, counselor or other professional
who can help
Connectedness to community, family, friends
Learned skills in problem solving and non-
violent conflict resolution
Cultural/religious beliefs that discourage suicide
Suicide Risk Factors
Yellow Light – Proceed with Caution
Mental disorders-particularly mood or eating
disorders
Substance abuse disorders
Family history of suicide
Hopelessness
Impulsive and /or aggressive tendencies
Barriers to accessing mental health treatment
Divorced parents or poor family communication
Suicide Risk Factors
Yellow Light – Proceed with Caution
Relational, social, work, or financial loss
Physical illness
Previous suicide act
Easy access to lethal methods, especially
guns
Age, Culture, Lack of connectedness
Exposure to sensational media reports of
suicide
Suicide Warning Signs
Red Light – Stop – Get Help
• Talking, reading, or writing about suicide/death.
• Talking about feeling worthless or helpless.
• Saying ―I’m going to kill myself,‖ ―I wish I was
dead,‖ or ―I shouldn’t have been born.‖
• Visiting or calling people to say goodbye.
• Giving things away or returning borrowed items.
• Self destructive or reckless behavior.
• Significant change in behavior
• Running away
Suicide Warning Signs
Red Light – Stop – Get Help
Hopelessness – typical hopeless statements:
– ―There’s no point in going on‖
– ―I can’t take it anymore‖
– ―I have nothing left to live for‖
– ―I can’t stop the pain‖
– ―I can’t live without _______‖
– ―My life keeps getting worse and worse‖
– ―I might as well kill myself‖
Why should Schools be
Involved?
Children come into contact with more
potential rescuers in the schools than in the
community
Children’s problems are often more
apparent in the school than in the home
Children from divorced and/or
dysfunctional families are less likely to get
help at home
Guetzloe, 1991
School Specific Signs of Distress
Any sudden or dramatic change should be
taken seriously, such as:
An overall decline in grades
Decrease in effort
Misconduct in the classroom
Unexplained or repeated absence or truancy
Who Should Intervene?
Not everyone who works with teenagers should
work with a suicidal teenager.
Know your limitations
Get someone else to help if you:
– Are a recent suicide survivor
– Are experiencing suicidal thoughts yourself
– Are experiencing significant stress in your own life
– If you have negative personal feelings about the teen
What do Educators Need to
Know?
There is no confidentiality when a child is
talking about suicide
Act immediately. Do not wait until class is
over or until the end of the day.
Take action even if you are not sure
http://www.nea.org/neatoday/0004/health.htm
l
What action?
Immediately contact the school
counselor/social worker or school
administrator
The school counselor/social worker or
school administrator will then contact the
student’s parents or guardian
Keep the student under supervision at all
times until someone else takes over.
What Can YOU Say?
I’m glad you told me, I want to
help.
I’m glad you told me, and I am
going to find someone to help you.
I will stay with you until help
arrives.
What NOT to Say…
• ―It’s just a phase‖
• ―You’ll snap out of it‖
• ―Stop being so selfish‖
• ―You’re just trying to get attention‖
• ―Get over it‖
What NOT to do….
Don’t let them bargain you out of getting
them help.
Be careful with no-suicide contracts
Don’t make coercive statements, such as
―unless you promise not to hurt yourself,
you’ll have to go to the hospital‖
Postvention after a Suicide
Goals:
Return the school to its pre-crisis milieu
Identify, refer, and/or assist students who
may be at risk for depression, suicide, and
other psychological problems due to their
exposure and relationship to the victim
Help students begin a healthy grieving
process
Kerr, Brent and McKain, 1997
Guidelines for postvention with
students
Explain that it is normal to feel emotions
such as shock, fear, sadness, guilt or anger.
Let students know there is no ―right way‖ to
feel after a suicide.
Help to clarify facts about the suicide. Ask
students to tell you what they have heard.
Correct errors and rumors if necessary.
Postvention Guidelines (cont)
Stress that no one is to blame for the
suicide. The victim alone made the
decision to commit suicide.
Focus on recovery of the survivors and
alternate methods of dealing with
problems.
Rehearse possible condolence
messages to the family.
Kerr, Brent, McKain 1997
Postvention
Emphasize that help is available to all
students, not just to those students who
are feeling suicidal.
Make sure students know where to go
to get help for themselves or for a
friend who is depressed or suicidal.
Kerr, Brent, McKain 1997
What NOT to do after a suicide:
Do not put in a permanent memorial for the
person who killed themselves. (i.e., no tree
planting, plaques, etc.)
Do not glorify the death by having large
memorial services with lots of fanfare.
The Southeast Nebraska Suicide
Prevention Project
Lead Agency:
Blue Valley Mental Health Center
Project Partners:
Bryan/LGH Medical Center
Community Mental Health Center of
Lancaster County
Resources
The Yellow Ribbon Program
www.yellowribbon.org
The National Suicide Hopeline
1-800-SUICIDE
BryanLGH Counseling Center
481-5991
BryanLGH 24-hour Mental Health Assistance Nurse
475-1011 OR 1-800-742-7845
AFSP Teen Suicide Prevention Kit
1-888-333-AFSP
American Association of Suicidology www.suicidology.org
Postvention Guideline Resources
Services for Teens at Risk (STAR):
http://www.wpic.pitt.edu/research/star/default.htm
Postvention Standards Guidelines: A guide for
a school’s response in the aftermath of a
sudden death. Kerr, Mary Margaret, Ed.D.,
Brent, David A., M.D., McKain, Brian,
M.S.N.. Star Center Publications, 3rd Edition.
School Curriculum Caveat
According to the American Academy of Child
Psychiatry:
Teaching entire courses on suicide to groups of
students should be discouraged as it appears to
activate suicidal ideation in disturbed adolescents.
Courses on teaching problem solving, social skills,
conflict resolution, and reporting skills are helpful
in preventing suicide in teens.
School Curriculum Suggestions
The National Education Association suggests:
Don’t sensationalize or normalize suicide
General education programs that teach the facts,
warning signs, and risk factors associated with
suicide do impart knowledge.
Treat suicide prevention within a broader mental
health focus—including work on enhancing
coping skills and dealing with risk factor issues
like substance abuse.
Steps parents can take
1. Get your child help (medical or mental
health professional)
2. Support your child (listen, avoid undue
criticism, remain connected)
3. Become informed (library, local support
group, Internet)
4. Restrict access to firearms
Carol Watkins, M.D.
Steps teens can take
1. Take your friend’s actions seriously
2. Encourage your friend to seek
professional help, accompany if necessary
3. Talk to an adult you trust. Don’t be alone
in helping your friend. Carol Watkins, M.D.
4. Don’t keep the secret.