1 school suicide prevention, intervention and postvention lashante smith, csus graduate student,...

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School Suicide Prevention,School Suicide Prevention,Intervention and PostventionIntervention and Postvention

LaShante Smith, CSUS graduate student,Crystal Courtright, CSUS graduate student,Stephen E. Brock, PhD, NCSP, LEPCalifornia State University, Sacramento

[email protected]

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Introduction◦ Suicide Statistics

Primary Prevention of SuicideSecondary Prevention of Suicide

◦ General Staff Procedures◦ Risk Assessment and Referral Protocol

Suicide Postvention

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Presentation OutlinePresentation Outline

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National Youth Suicide National Youth Suicide StatisticsStatisticsFifth leading cause of death among 5-14 year

olds in 2009 (N = 266; 0.7:100,000).◦ Third leading cause in the 10-14 age group, N =

259).

Third leading cause of death among 15-24 year olds in 2009 (N = 4,371; 10.1:100,000).

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Source: Kochanek, K. D., et al. (2011, March). Deaths: Preliminary data for 2009. National Vital Statistics Report, 59(4), 1-51. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_04.pdf

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National Youth Suicide National Youth Suicide StatisticsStatistics2011 YRBS1

◦ 15.8% of high school students reported having seriously considered suicide.

◦ 12.8% reported having made a suicide plan.◦ 7.8% of high school students reported having attempted

suicide.◦ 2.4% indicated that the attempt required medical attention.

100 to 200 attempts for each completed youth suicide. ◦ vs. 4 attempts for each completed suicide among

the elderly.2

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1Eaton, D. K. et al. (2012, June). Youth Risk Behavior Surveillance — United States, 2011. Morbidity and Mortality Weekly Report, 61(SS-4), 1-162. Retrieved from http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf

2McIntosh, J. L. (2011, October). USA suicide: 2008 final data. Washington, DC: American Association of Suicideology. Retrieved from http://www.suicidology.org/c/document_library/get_file?folderId=228&name=DLFE-392.pdf

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Other Suicide Facts: All Age Other Suicide Facts: All Age GroupsGroups

Total number of deaths (N = 36,909; 12.02:100,000)◦ 10th leading cause of death◦ Highest rate in 15 years.

More men die by suicide◦ 3.72 male suicides (N = 29,089) for each females

suicide (N = 7,820)

5Source: CDC. (2011). http://webappa.cdc.gov/cgi-bin/broker.exe

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Total US Suicide Rate Total US Suicide Rate (1981-2009)(1981-2009)

6Source: CDC (2011)

Suicide Rate (per 100, 000)

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Other Suicide Facts: All Age Other Suicide Facts: All Age GroupsGroups50.6% of suicides are by firearms.1

◦ Suicide by firearms rate = 6.0:100,000◦ N = 18,223

Highest suicide rate is among white men over 85 (48.77:100,000 vs 11.82:100,000 among white male adolescent 15-19).2

◦ However the 2nd highest rate is among American Indian/Alaskan Native 20-24 year-old males (38.9:100,000).

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1McIntosh, J. L. (2011, October). USA suicide: 2008 final data. Washington, DC: American Association of Suicideology. Retrieved from http://www.suicidology.org/c/document_library/get_file?folderId=228&name=DLFE-392.pdf

2Nantional Center for Injury Prevention and Control. (2011, December). WISQARS Injury Mortality Reports, 1999-2007. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from http://webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html

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Suicide Rates by State Suicide Rates by State (2009 Final (2009 Final Data)Data)

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Rank State (2008 rank) #Crude Rate

1. Montana 219 22.462. Alaska 143 20.473. Wyoming 111 20.394. Idaho 304 19.675. Nevada 505 19.116. Colorado 941 18.737. New Mexico 376

18.718. Oregon 644 16.839. Utah 449 16.1210. Arizona 1,060 16.0742. California 3,823 10.30National Total 36,909 12.02

Source: CDC (2011)

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US Suicide Rates by Age & Gender US Suicide Rates by Age & Gender (2009 data)

Suic

ide R

ate

(per

10

0, 0

00

)

Source: CDC (2011) 9

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Youth Risk Behavior Survey - Youth Risk Behavior Survey - 20112011

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• During the 12 months before the survey, what percentage of students engaged in a variety of risky behaviors

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High School Students who Felt High School Students who Felt ““sad or hopelesssad or hopeless””

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Perc

en

t

Youth Risk Behavior Survey (2012)

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High School Students who High School Students who ““seriously considered seriously considered attempting suicideattempting suicide””

12

Perc

en

t


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High School Students who High School Students who ““made a plan about how they made a plan about how they would attempt suicidewould attempt suicide””

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Perc

en

t


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High School Students who High School Students who ““attempted suicide one or more attempted suicide one or more timestimes””

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Perc

en

t


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High School Students who High School Students who ““made a made a suicide attempt that … had to be suicide attempt that … had to be treated by a doctor or nursetreated by a doctor or nurse””

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Perc

en

t


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High School Students who High School Students who Display Suicidal BehaviorsDisplay Suicidal Behaviors

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Perc

en

t



Primary Prevention of Suicide◦ Preventing Suicidal Ideation and Behavior

Secondary Prevention of Suicide◦ General Staff Procedures◦ Risk Assessment and Referral Protocol

Suicide Postvention

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What is the School PsychologistWhat is the School Psychologist’’s s role in preventing suicide in role in preventing suicide in

schools? schools?

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• School provides ideal opportunities for quality suicide prevention messages.

• We are leaders in the school in developing a comprehensive crisis management system

KING, K. A., STRUNK, C. M., & SORTER, M. T. (2011). Preliminary Effectiveness of Surviving the Teens® Suicide Prevention and Depression Awareness Program on Adolescents' Suicidality and Self-Efficacy in Performing Help-Seeking Behaviors. Journal Of School Health, 81(9)

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Primary Prevention: Primary Prevention: PolicyPolicy It is the policy of the Governing Board that all

staff members learn how to recognize students at risk, to identify warning signs of suicide, to take preventive precautions, and to report suicide threats to the appropriate parental and professional authorities.

Administration shall ensure that all staff members have been issued a copy of the District's suicide prevention policy and procedures. All staff members are responsible for knowing and acting upon them.

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Primary Prevention:Primary Prevention:Gatekeeper TrainingGatekeeper TrainingTraining natural community caregiversAdvantages

◦ Reduced risk of imitation◦ Expands community support systems

Research is limited but promising◦ Durable changes in attitudes, knowledge,

intervention skills

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Primary Prevention:Primary Prevention:Gatekeeper TrainingGatekeeper TrainingA Specific Training Program: Applied Suicide Intervention Skills Training

◦ Author: Ramsay, Tanney, Tierney, & Lang◦ Publisher: LivingWorks Education, Inc◦ 1-403-209-0242◦ http://www.livingworks.net/

Since 1985, ASIST has been delivered to over one million caregivers in more than 10 countries. Today 5,000 registered trainers deliver ASIST around the world. ASIST is a recognized exemplary program (CDC, 1992). The program has been evaluated by more than 15 independent evaluations.

Training for Trainers is a five-day course that prepares local resource persons to be trainers of the ASIST workshop. Around the world, there is a network of 1000 active, registered trainers. 21

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Primary Prevention:Primary Prevention:CurriculumCurriculumSOS: Depression Screening and Suicide

Prevention ◦ “The main teaching tool of the SOS program is

a video that teaches students how to identify symptoms of depression and suicidality in themselves or their friends and encourages help-seeking. The program's primary objectives are to educate teens that depression is a treatable illness and to equip them to respond to a potential suicide in a friend or family member using the SOS technique. SOS is an action-oriented approach instructing students how to ACT (Acknowledge, Care and Tell) in the face of this mental health emergency.”

◦ Evidenced based!22

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Primary Prevention:Primary Prevention:ScreeningScreeningSchool-wide Screening

◦ Very few false negatives◦ Many false positives

Requires second-stage evaluationLimitations

◦ Risk waxes and wanes◦ Principals’ view of acceptability ◦ Requires effective referral procedures

Possible Tools◦ Suicidal Ideation Questionnaire (William Reynolds,

Psychological Assessment Resources)◦ Columbia Teen Screen (Columbia University)◦ Beck Depression Inventory◦ SOS Depression Screening and Suicide Prevention

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Primary Prevention:Primary Prevention:ScreeningScreening

http://www.teenscreen.org/ 24

Middle & High School Age Youth

Parent Consent and Participant Assent

Screening Questionnaire

Clinical Interview

Parent Notification, Referral and Crisis Management

Debriefing

No Referral

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Primary Prevention:Primary Prevention:Suicide Prevention & Crisis HotlinesSuicide Prevention & Crisis HotlinesRationale

◦ Suicidal ideation is associated with crisis◦ Suicidal ideation is associated with

ambivalence◦ Special training is requires to respond to

“cries for help”Likely benefit those who use themLimitations

◦ Limited research regarding effectiveness◦ Few youth use hotlines◦ Youth are less likely to be aware of hotlines◦ Highest risk youth are least likely to use

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Primary Prevention:Primary Prevention:Suicide Prevention & Crisis HotlinesSuicide Prevention & Crisis Hotlines

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Primary Prevention:Primary Prevention:Risk Factor ReductionRisk Factor Reduction

Restriction of Lethal Means

Media Education

Postvention

Skills Training

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Primary Prevention: Primary Prevention: Risk Factor ReductionRisk Factor Reduction

Restriction of Lethal Means: Gun Control

28Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5209a1.htm

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Protective factors in preventing Protective factors in preventing suicidesuicide

• Family support and cohesion, including good communication.• Peer support and close social networks.• School and community connectedness.• Cultural or religious beliefs that discourage suicide and

promote healthy living.• Adaptive coping and problem-solving skills, including

conflict-resolution.• General life satisfaction, good self-esteem, sense of purpose.• Easy access to effective medical and mental health resources.

29Source: http://www.nasponline.org/resources/crisis_safety/suicideprevention.aspx



◦ Suicide Intervention General Staff Procedures Risk Assessment and Referral Protocol

Suicide Postvention

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Duty to WarnDuty to WarnWhen a student is a danger to

self or others there is a duty to warn.◦Tarasoff v. Regents of the University

of California

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General Staff ProceduresGeneral Staff ProceduresResponding to a Threat of Suicide.

◦A student who has threatened suicide must be carefully observed at all times until a qualified staff member can conduct a risk assessment.

◦The following procedures are to be followed whenever a student directly or indirectly threatens to commit suicide.

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1. Stay with the student or designate another adult staff member to supervise the youth suspected to be at risk for suicide constantly until help arrives.

2. If the student has the means to carry out suicide on his or her person, determine if he or she will voluntarily relinquish it.

◦ Do not force the student to do so or place yourself in danger.

◦ If the student refuses to relinquish lethal means:1. Protect yourself and your students.2. Have the school office call 911.

3. Unless doing so would put yourself or your students in danger do not allow the student to leave the school.

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General Staff ProceduresGeneral Staff Procedures

4. Do not agree to keep a student's suicidal intentions a secret.

5. Take the student to the prearranged room.

6. Notify the Designated Reporter (e.g., school psychologist or counselor).

7. Notify the School Principal (or other designated administrator).

8. Inform the youth that outside help has been called and describe what the next steps will be.

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Requires that school staff members have…◦ Knowledge of the risk factors the increase

the odds of suicide. Variables that should direct our attention.

◦ Been trained to identify direct and indirect threats (or warning signs) that indicate the presence of suicide. Variables that should direct our action.

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Risk Factors for Suicide◦ Biological

Reduced serotongenic activity

◦ Situational 40% have identifiable precipitants A firearm in the home By themselves are insufficient Disciplinary crisis most common

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Risk Factors for Suicide◦ Psychopathology

Associated with 90% of suicides Prior suicidal behavior the best predictor Substance abuse increases vulnerability and

can also act as a trigger

◦ Familial History Stressor Functioning

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Adolescence and late life

Bisexual or homosexual gender identity

Criminal behaviorCultural sanctions for

suicideDelusionsDisposition of personal

property

Divorced, separated, or single marital status

Early loss or separation from parents

Family history of suicide

HallucinationsHomicideHopelessnessHypochondriasis

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Risk Factors for SuicideGeneral Staff ProceduresGeneral Staff Procedures

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Warning Signs for Suicide◦ Verbal

Most individuals give verbal clues that they have suicidal thoughts.

Clues include direct ("I have a plan to kill myself”) and indirect suicide threats (“I wish I could fall asleep and never wake up”).

◦ Behavioral

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Verbal Warnings Signs of Suicide1. “Everybody would be better off if I just weren’t

around.”2. “I’m not going to bug you much longer.”3. “I hate my life. I hate everyone and everything.”4. “I’m the cause of all of my family’s/friend’s

troubles.”5. “I wish I would just go to sleep and never wake

up.”6. “I’ve tried everything but nothing seems to help.”7. “Nobody can help me.”8. “I want to kill myself but I don’t have the guts.”9. “I’m no good to anyone.”10. “If my (father, mother, teacher) doesn’t leave me

alone I’m going to kill myself.”11. “Don’t buy me anything. I won’t be needing any

(clothes, books).”

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Behavioral Warning Signs of Suicide

1. Writing of suicidal notes2. Making final arrangements3. Giving away prized possessions4. Talking about death5. Reading, writing, and/or art about death6. Hopelessness or helplessness7. Social Withdrawal and isolation8. Lost involvement in interests & activities9. Increased risk-taking10.Heavy use of alcohol or drugs

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Behavioral Warning Signs of Suicide (cont.)11.Abrupt changes in appearance12.Sudden weight or appetite change13.Sudden changes in personality or attitude14.Inability to concentrate/think rationally15.Sudden unexpected happiness16.Sleeplessness or sleepiness17.Increased irritability or crying easily18.Low self esteem

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Behavioral Warning Signs of Suicide (cont.)19.Dwindling academic performance20.Abrupt changes in attendance21.Failure to complete assignments22.Lack of interest and withdrawal23.Changed relationships24.Despairing attitude

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◦ Preventing Suicidal Behavior General Staff Procedures Risk Assessment and Referral Protocol

Suicide Postvention

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Whenever a student judged to have some risk of engaging in self-directed violence or suicide, a school-based mental health professional should conduct a risk assessment and make the appropriate referrals.

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Risk Assessment and Risk Assessment and Referral ProtocolReferral Protocol

Risk Assessment and Risk Assessment and Referral ProtocolReferral Protocol1. Identify suicidal thoughts.

2. Conduct a risk assessment and make appropriate referrals.

a) Consult with fellow school staff members regarding the risk assessment and referral options.

b) Consult with County Mental Health regarding the risk assessment and referral options.

c) As indicated, consult with local law enforcement about referral options.

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3. Use risk assessment information and consultation guidance to develop an action plan.Action plan options are as follows:

A. Extreme Risk If the student has the means of his or her

threatened suicide at hand, and refuses to relinquish such then follow the Extreme Risk Procedures.

B. Crisis Intervention Referral If the student's risk of suicide is judged to

be moderate to high, but means of violence are not at hand, then follow the Crisis Intervention Referral Procedures.

C. Mental Health Referral If the student's risk of suicide is judged to

be low and means of violence are not at hand, then follow the Mental Health Referral Procedures.

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A. Extreme Riski. Have school administration call the police.

ii. If it is judged safe to do so, attempt to calm the student by talking and reassuring him or her until the police arrive.

iii. If it is judged safe to do so, continue to request that the student relinquish the means his or her threatened suicide and try to prevent the student from harming self or others.

iv. Call the parents and inform them of the actions taken.

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B. Crisis Intervention Referrali. Determine if the student's distress is the

result of parent or caretaker abuse, neglect, or exploitation.

ii. Meet with the student's parents or caregivers.

iii. Determine what to do if the parents or caregivers are unable or unwilling to assist with the crisis.

iv. Make appropriate referrals.

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C. Mental Health Referrali. Determine if the student's distress is the

result of parent or caretaker abuse, neglect, or exploitation.

ii. Meet with the student's parents or caregivers.

iii. Make appropriate referrals.

4. Protect the privacy of the student and family.

5. Follow-up with the referral resources (e.g., hospital or clinic).

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Asking the “S” Question◦ The presence of suicide warning signs,

especially when combined with suicide risk factors generates the need to conduct a suicide risk assessment.

◦ Risk assessment begins with asking if the student is having thoughts of suicide.

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Suicide Risk Assessment Suicide Risk Assessment

Its Your Turn….Its Your Turn….Imagine you are working with a

student that may be suicidal. How you would ask the question.

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Identification of Suicidal Intent◦ Be direct when asking the “S” question.

BAD You’re not thinking of hurting yourself, are you?

Better Are you thinking of harming yourself?

BEST Sometimes when people have had your experiences and feelings they have thoughts of suicide. Is this something that you’re thinking about?

How did you do?

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Predicting Suicidal Behavior (CPR++): Current Factors◦ Current plan (greater planning = greater risk).

How (method of attempt)? How soon (timing of attempt)? How prepared (access to means of attempt)?

◦ Pain (unbearable pain = greater risk) How desperate to ease the pain?

Person-at-risk’s perceptions are key◦ Resources (more alone = greater risk)

Reasons for living/dying? Can be very idiosyncratic Person-at-risk’s perceptions are key

54Ramsay, Tanney, Lang, & Kinzel (2004)


Predicting Suicidal Behavior (CPR++): Historical Factors◦ (+) Prior Suicidal Behavior?

of self (40 times greater risk) of significant others An estimated 26-33% of adolescent suicide

victims have made a previous attempt (American Foundation or Suicide Prevention, 1996).

◦ (+) Mental Health Status? history mental illness (especially mood

disorders) linkage to mental health care provider

55Ramsay, Tanney, Lang, & Kinzel (2004)


Standardized Risk Screening Tools◦ Beck Scale for Suicidal Ideation (BSI)

21 item self-report for adolescents Best to detect and measure severity of

ideation One of only scales to assess active and

passive ideation◦ Suicidal Ideation Questionnaire (SIQ)

Severity or seriousness of ideation Two version for 7-9th and 10-12th grades Draw-back: No item regarding past or

current suicide attempts

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Suicide Risk Assessment Summary

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Responding to At-Risk YouthResponding to At-Risk Youth1. Teach appropriate behavior and social problem-

solving skills in the classroom or in a small group setting.

2. Additional problems or risk factors are addressed through determining student and family needs.

◦ Referrals made to appropriate support systems.3. Protective factors for student are analyzed and

provisions made to continue or to add to these factors, which provide support for the at-risk student.

◦ For example, provide an adult mentor who meets periodically with the student.

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Responding to High Risk Responding to High Risk YouthYouth4. Determine if there are any imminent warning

signs. ◦ If there are, then refer student for an immediate

suicide and/or homicide risk assessment. 5.

6. If imminent warning signs are not present, then give the student a high priority for a Student Success Team Meeting. 4. Assign a Student Success Team member (e.g.,

principal, school psychologist, or teacher) to provide informal consultation until a formal meeting may be scheduled.

At the SST meeting, develop recommendations for responding to high-risk youth and consider the need for a referral for Special Education services.

Consider a referral to school site mental health and community-based mental health services. 59

Responding to High Risk Responding to High Risk YouthYouth9. Consider the need to revise student’s

behavior contract and/or to conduct a more in-depth functional assessment.

10. Obtain parental permission to exchange information with the appropriate community agencies to determine if student is eligible for additional services.◦ If available, call a meeting with other agency

personnel to focus on provisions for wrap-around intervention and support for the student and family.

11. Develop an action plan for immediate interventions that includes provisions for increased supervision.

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◦ General Staff Procedures◦ Risk Assessment and Referral Protocol

Suicide Postvention

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School Suicide School Suicide PostventionPostvention

“… the largest public health problem is neither the prevention of suicide nor the management of suicide attempts, but the alleviation of the effects of stress on the survivors whose lives are forever altered.”

E.S. ShneidmanForward to Survivors of SuicideEdited by A. C. CainPublished by Thomas, 1972

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Key Terms and Statistics◦ Suicide postvention

… is the provision of crisis intervention, support and assistance for those affected by a completed suicide.

Affected individuals includes both “survivors” and other persons who were “exposed” to the death.

63Andriessen & Krysinska (2012)


Key Terms and Statistics◦ Survivors of suicide

“the family members and friends who experience the suicide of a loved one” (McIntosh, 1993, p. 146).

“a person who has lost a significant other (or a loved one) by suicide, and whose life is changed because of the loss” (Andriessen, 2009, p. 43).

“… someone who experiences a high level of self-perceived psychological, physical, and/or social distress for a considerable length of time after exposure to the suicide of another person” (Jordan & McIntosh, 2011, p. 7).

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65


66Andriessen & Krysinska (2012)


67Grad et al. (2004)

Special Issues in Special Issues in PostventionPostventionFactors that make the postvention

response a special and unique form of crisis intervention.1. Suicide contagion2. A special form of bereavement3. Social stigma4. Developmental differences5. Cultural differences

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American Foundation for Suicide Prevention (2001); Cain (1972); De Groot et al. (2006); Jordan & McIntosh (2011); Jordan (2001); Mishara (1999); O’Carroll & Potter (1994); Ramsay et al. (1999); Roberts et al.

(1998); Sonneck et al. (1994)

Suicide ClustersSuicide Clusters1. Suicide contagion

◦ 2006-2010 700 CA youth committed suicide (ages 15-19)

A state-wide average of 140 suicides per year Among 15-19 year olds, a state-wide average annual

rate of 5 per 100,000 individuals.

A 1,000 student high school can expect a completed suicide once every 20 years.

A 2,000 student high school can expect a completed suicide once every 10 years.

69Kidsdata.org (2012); US Census Bureau (2012)

Number of Suicides Population

x selected proportion of population = Rate

140

2,823,940

x 1,000 = 0.05

140 2,823,940

x 100,000 = 5

140

2,823,940

x 2,000 = 0.1

Suicide ClustersSuicide Clusters1. Suicide contagion

◦ Percent of CA high school students with a self-reported attempt (in the 12 months prior to survey) that required medical attention.

70CDC (2012, June 8)

Postvention ProtocolPostvention Protocol

71

1. Verify the death2. Mobilize the Crisis Team

3. Assess impact & determine response

4. Notify affected school staff members

5. Contact the deceased’s family 6. Determine what to share7. Determine how to inform

others8. Identify crisis intervention

priorities9. Faculty planning session

10. Provide crisis intervention services

11. Ongoing daily planning sessions

12. Memorials13. Debrief

American Foundation for Suicide Prevention et al. (2011). http://www.suicidepreventionlifeline.org/App_Files/Media/PDF/sprc_online_library.pdf


1. Verify that a death has occurred◦ Confirm the cause of death

Confirmed suicide Unconfirmed cause of death

72Brock (2002)


2. Mobilize the crisis response team

73Brock (2002)

Postvention ProtocolPostvention Protocol3. Assess the suicide’s impact on the

school and estimate the level of response required.

◦ The importance of accurate estimates. Make sure a postvention is truly needed

before initiating this intervention.◦ Temporal proximity to other traumatic

events (especially suicides).◦ Timing of the suicide.◦ Physical and/or emotional proximity to the

suicide.

74Brock (2002)

Postvention ProtocolPostvention Protocol4. Notify other involved school staff

members.◦Deceased student’s teachers (current

an former)◦Any other staff members who had a

relationship with the deceased◦Teachers and staff who work with

suicide survivors.

75Brock (2002)


5. Contact the family of the suicide victim.

◦ Purposes include... Express sympathy and offer support. Identify the victim’s friends/siblings who may need

assistance. Discuss the school’s response to the death. Identify details about the death could be shared

with outsiders.

76Brock (2002); American Foundation for Suicide Prevention et al. (2011)


6. Determine what information to share about the death

◦ Several different communications may be necessary When the death has been ruled a suicide When the cause of death is unconfirmed When the family has requested that the

cause of death not be disclosed Templates provided in After a Suicide:

A Toolkit for Schools”


Postvention ProtocolPostvention Protocol6. Determine what information to share

about the death◦ Avoid detailed descriptions of the suicide

including specific method and location.◦ Avoid over simplifying the causes of suicide

and presenting them as inexplicable or unavoidable.

◦ Avoid using the words “committed suicide” or “failed suicide.”

◦ Always include a referral phone number and information about local crisis intervention services

◦ Emphasize recent treatment advances for depression and other mental illness.


Postvention ProtocolPostvention Protocol7. Determine how to share information

about the death.◦ Reporting the death to students...

Avoid tributes by friends, school wide assemblies, sharing information over PA systems that may romanticize the death Positive attention given to someone who has

died (or attempted to die) by suicide can lead vulnerable individuals who desire such attention to take their own lives.

Provide information in small groups (e.g., classrooms).

79Brock, 2002


about the death.◦ Reporting the death to the media...

It is essential that the media not romanticize the death.

The media should be encouraged to acknowledge the pathological aspects of suicide.

Photos of the suicide victim should not be used. “Suicide" should not be placed in the caption . Include information about the community

resources. Sample media statement provided in

“After a Suicide: A Toolkit for Schools”

80Brock, 2002; American Foundation for Suicide Prevention et al. (2011)


about the death.◦ Reporting the death to the media: Guidelines

from the World Health Organization1. Suicide is never the result of a single incident2. Avoid providing details of the method or the

location a suicide victim uses that can be copied3. Provide the appropriate vital statistics (i.e., as

indicated provide information about the mental health challenges typically associated with suicide).

4. Provide information about resources that can help to address suicidal ideation.

81Brock (2002); World Health Organization (2000)

Postvention ProtocolPostvention Protocol8. Identify students significantly affected

by the suicide and initiate referral procedures.

◦ Risk Factors for Imitative Behavior Facilitated the suicide. Failed to recognize the suicidal intent. Believe they may have caused the suicide. Had a relationship with the suicide victim. Identify with the suicide victim. Have a history of prior suicidal behavior. Have a history of psychopathology. Shows symptoms of helplessness and/or hopelessness. Have suffered significant life stressors or losses. Lack internal and external resources

82Brock (2002); Brock & Sandoval (1996)

Postvention ProtocolPostvention Protocol9. Conduct a faculty planning session.

◦ Share information about the death. ◦ Allow staff to express their reactions and grief..◦ Provide a scripted death notification statement for

students.◦ Prepare for student reactions and questions ◦ Explain plans for the day.◦ Remind all staff of the role they play in identifying

changes in behavior and discuss plan for handling students who are having difficulty.

◦ Brief staff about identifying and referring at-risk students as well as the need to keep records of those efforts.

◦ Apprise staff of any outside crisis responders or others who will be assisting.

◦ Remind staff of student dismissal protocol for funeral.◦ Identify which Crisis Response Team member has been

designated as the media spokesperson and instruct staff to refer all media inquiries to him or her. 83Brock (2002); American Foundation for Suicide Prevention et al. (2011)

Postvention ProtocolPostvention Protocol10. Initiate crisis intervention services

a) Initial intervention options… Individual psychological first aid. Group psychological first aid. Classroom activities and/or presentations. Parent meetings. Staff meetings.

b) Walk through the suicide victim’s class schedule.c) Meet separately with individuals who were proximal to

the suicide.d) Identify severely traumatized and make

appropriate referrals.e) Facilitate dis-identification with the suicide

victim… Do not romanticize or glorify the victim's behavior

or circumstances. Point out how students are different from the

victim.f) Parental contact.g) Psychotherapy Referrals.

84Brock (2002)

Postvention ProtocolPostvention Protocol11. Consider memorials

◦“A delicate balance must be struck that creates opportunities for students to grieve but that does not increase suicide risk for other school students by glorifying, romanticizing or sensationalizing suicide.”

85Center for Suicide Prevention (2004)

Postvention ProtocolPostvention Protocol11. Consider memorials Do NOT . . .

◦send all students from school to funerals, or stop classes for a funeral.

◦have memorial or funeral services at school.

◦establish permanent memorials such as plaques or dedicating yearbooks to the memory of suicide victims.

◦dedicate songs or sporting events to the suicide victims.

◦fly the flag at half staff.◦have assemblies focusing on the suicide

victim, or have a moment of silence in all-school assemblies.

86Brock & Sandoval (2006)

Postvention ProtocolPostvention Protocol11. Consider memorials DO . . .

◦ something to prevent other suicides (e.g., encourage crisis hotline volunteerism).

◦ develop living memorials, such as student assistance programs, that will help others cope with feelings and problems.

◦ allow students, with parental permission, to attend the funeral.

◦ Donate/Collect funds to help suicide prevention programs and/or to help families with funeral expenses

◦ encourage affected students, with parental permission, to attend the funeral.

◦ mention to families and ministers the need to distance the person who committed suicide from survivors and to avoid glorifying the suicidal act.

87Brock & Sandoval (2006)

Postvention ProtocolPostvention Protocol12. Debrief the postvention response.

◦ Goals for debriefing will include… Review and evaluation of all crisis intervention

activities. Making of plans for follow-up actions. Providing an opportunity to help intervenors cope.

88Brock (2002)

Concluding ObservationConcluding Observation“… the person who commits suicide

puts his psychological skeleton in the survivor’s emotional closet; he sentences the survivor to deal with many negative feelings and more, to become obsessed with thoughts regarding the survivor’s own actual or possible role in having precipitated the suicidal act or having failed to stop it. It can be a heavy load” (p. x).

89Shneidman (1972)

Selected ReferencesSelected ReferencesAmerican Foundation for Suicide Prevention and Suicide Prevention Resource Center. (2011). After a

suicide: A toolkit for schools. Newton, MA: Education Development Center. Retrieved from http://www.suicidepreventionlifeline.org/App_Files/Media/PDF/sprc_online_library.pdf

American Foundation for Suicide Prevention, American Association of Suicideology, & Annenberg Public Policy Center. (2001). Reporting on suicide: Recommendations for the media. Retrieved from http://www.suicidology.org/c/document_library/get_file?folderId=231&name=DLFE-71.pdf

Andriessen, K. (2009). Can postvention be prevention? Crisis, 30, 43-47.

Andriessen, K., & Krysinska, K. (2012). Essential questions on suicide bereavement and postvention. International Journal of Environmental Research and Public Health, 9, 24-32. doi:10.3390/ijerph9010024

Berman, A. L. Estimating the population of survivors of suicide: Seeking an evidence base. Suicide & Life Threatening Behavior, 41, 110-116.

Brock, S. E. (2002). School suicide postvention. In S. E. Brock, P. J. Lazarus, & S. R. Jimerson (Eds.), Best practices in school crisis prevention and intervention (pp. 553-575). Bethesda, MD: National Association of School Psychologists.

Brock, S. E. (2003, May). Suicide postvention. Paper presented at the DODEA Safe Schools Seminar. Retrieved from http://www.dodea.edu/dodsafeschools/members/seminar/SuicidePrevention/generalreading.html#2

Brock, S. E., Sandoval, J., & Hart, S. R. (2006). Suicidal ideation and behaviors. In G Bear & K Minke (Eds.), Children’s needs III: Understanding and addressing the developmental needs of children (pp. 187-197). Bethesda, MD: National Association of School Psychologists

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Selected ReferencesSelected References

Cain, A. C. (Ed.). (1972). Survivors of Suicide. Springfield, IL, Thomas: Springfield, IL.

Centers for Disease Control and Prevention. (2012, March 9). Web-based injury statistics query and reporting system (WISQARS). Leading causes of death reports. Atlanta, GA: National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/injury/wisqars/index.html

Centers for Disease Control and Prevention. (2012, June 8). Youth risk behavior surveillance – United States, 2011, MMWR, 61(4), 1-162. Retrieved from http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf

Center for Suicide Prevention. (2004, May). School memorials after suicide: Helpful or harmful? Retrieved from www.suicideinfo.ca

Davis, J. M., & Brock, S. E. (2002). Suicide. In J. Sandoval (Ed.), Handbook of crisis counseling, intervention and prevention in the schools (2nd ed., pp. 273-299). Hillsdale, NJ: Lawrence Erlbaum Associates.

de Groot, M. H., de Keijeser, D., & Neeleman, J. (2006). Grief shortly after suicide and nautral death: A comparative study among spouses and first-degree relatives. Suicide and Life-Threatening Behavior, 36, 418-431.

Grad, O. T., Clark, S., Dyregrov, K., & Andriessen, K. (2004). What helps and what hinders the process of surviving the suicide of somebody close? Crisis, 25, 134-139.

Jordan, J. R. (2001). Is suicide bereavement different: A reassessment of the literature. Suicide & Life-Threatening Behavior, 31 91-102.

Jordan, J. R. & McIntosh, J. L. (2011). Suicide bereavement: Why study survivors of suicide loss? In J. R. Jordan, J. L. McIntosh (Eds.), Grief after Suicide (pp. 3-17). New York, NY: Routledge.

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Selected ReferencesSelected ReferencesJordan, J. R. (2001). Is suicide bereavement different: A reassessment of the literature. Suicide

& Life-Threatening Behavior, 31 91-102.

Jordan, J. R. & McIntosh, J. L. (2011). Suicide bereavement: Why study survivors of suicide loss? In J. R. Jordan, J. L. McIntosh (Eds.), Grief after Suicide (pp. 3-17). New York, NY: Routledge.

McIntosh, J. (1993). Control group studies of suicide survivors: A review and critique. Suicide Life & Threatening Behavior, 23, 146-161.

Mishara, B. L. (1999). Concepts of death and suicide in children ages 6-12 and their implications for suicide prevention. Suicide & Life-Threatening Behavior, 29, 105-118.

O’Carroll, P. W., & Potter, L. B. (1994, April 22). Suicide contagion and the reporting of suicide: Recommendations form a national workshop. MMWR, 43(RR-6), 11-19. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/00031539.htm

Ramsay, R. F., Tanney, B. L., Tierney, R. J., & Lang, W. A. (1996). Suicide intervention workshop (6th ed.). Calgary, AB: LivingWorks Education.

Roberts, R. L., Lepkowski, W. J., & Davidson, K. K. (1998). Dealing with the aftermath of a student suicide: A T.E.A.M. approach. NASSP Bulletin, 82, 53-59.

Scocco, P., Frasson, A., Costacurta, A., & Pavan, L. (2006). SPRPoxi: A research-intervention project for suicide survivors. Crisis, 27, 39-41.

Shneidman, E. (1969). Prologue: Fifty-eight years. In E. S. Scneidman (Ed.) On the nature of suicide (pp. 1-30). San Francisco, CA: Jossey-Bass.

Shneidman, E. (1972). Forward. In A. C. Cain (Ed.), Survivors of Suicide. Springfield, IL: Thomas.

Sonneck, G., Etzersdorfer., & Nagel-Kuess, S. (1994). Imitative suicide on the Viennese subway. Social Science & Medicine, 38(3), 453-457. doi: 10.1016/0277-9536(94)90447-2

Wrobleski, A. (2002). Suicide survivors: A guide for those left behind. Minneapolis, MN: SAVE.

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