If you are in crisis, 1st call 911 while you're looking in the front of your local yellow pages for the number of the local suicide prevention hotline. If you can't get through to either of those, click on Emergency Numbers. Also visit www.metanoia.org/suicide which contains conversations and writings for suicidal persons to read, gay youth suicide at www.sws.soton.ac.uk/gay-youth-suicide and youth: suicide at www.virtualcity.com/youthsuicide .
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A suicidal person may not ask for help, but that doesn't mean that help isn't wanted. People who take their lives don't want to diethey just want to stop hurting. Suicide prevention starts with recognizing the warning signs and taking them seriously. If you think a friend or family member is considering suicide, you might be afraid to bring up the subject. But talking openly about suicidal thoughts and feelings can save a life.
The World Health Organization estimates that approximately 1 million people die each year from suicide. What drives so many individuals to take their own lives? To those not in the grips of suicidal depression and despair, it's difficult to understand what drives so many individuals to take their own lives. But a suicidal person is in so much pain that he or she can see no other option.
Suicide is a desperate attempt to escape suffering that has become unbearable. Blinded by feelings of self-loathing, hopelessness, and isolation, a suicidal person can't see any way of finding relief except through death. But despite their desire for the pain to stop, most suicidal people are deeply conflicted about ending their own lives. They wish there was an alternative to suicide, but they just can't see one.
Common misconceptions about suicide
Myth: People who talk about suicide won't really do it.
Fact: Almost everyone who attempts suicide has given some clue or warning. Dont ignore even indirect references to death or suicide. Statements like "You'll be sorry when I'm gone," "I can't see any way out," no matter how casually or jokingly said, may indicate serious suicidal feelings.
Myth: Anyone who tries to kill him/herself must be crazy.
Fact: Most suicidal people are not psychotic or insane. They must be upset, grief-stricken, depressed or despairing, but extreme distress and emotional pain are not necessarily signs of mental illness.
Myth: If a person is determined to kill him/herself, nothing is going to stop them.
Fact: Even the most severely depressed person has mixed feelings about death, wavering until the very last moment between wanting to live and wanting to die. Most suicidal people do not want death; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.
Myth: People who die by suicide are people who were unwilling to seek help.
Fact: Studies of suicide victims have shown that more than half had sought medical help in the six months prior to their deaths.
Myth: Talking about suicide may give someone the idea.
Fact: You don't give a suicidal person morbid ideas by talking about suicide. The opposite is truebringing up the subject of suicide and discussing it openly is one of the most helpful things you can do.
Source: SAVE - Suicide Awareness Voices of Education
Most suicidal individuals give warning signs or signals of their intentions. The best way to prevent suicide is to recognize these warning signs and know how to respond if you spot them. If you believe that a friend or family member is suicidal, you can play a role in suicide prevention by pointing out the alternatives, showing that you care, and getting a doctor or psychologist involved.
Major warning signs for suicide include talking about killing or harming oneself, talking or writing a lot about death or dying, and seeking out things that could be used in a suicide attempt, such as weapons and drugs. These signals are even more dangerous if the person has a mood disorder such as depression or bipolar disorder, suffers from alcohol dependence, has previously attempted suicide, or has a family history of suicide.
A more subtle but equally dangerous warning sign of suicide is hopelessness. Studies have found that hopelessness is a strong predictor of suicide. People who feel hopeless may talk about "unbearable" feelings, predict a bleak future, and state that they have nothing to look forward to.
Other warning signs that point to a suicidal mind frame include dramatic mood swings or sudden personality changes, such as going from outgoing to withdrawn or well-behaved to rebellious. A suicidal person may also lose interest in day-to-day activities, neglect his or her appearance, and show big changes in eating or sleeping habits.
Suicide warning signs
Talking about suicide Any talk about suicide, dying, or self-harm, such as "I wish I hadn't been born," "If I see you again..." and "I'd be better off dead."
Suicide prevention tip 1: Speak up if youre worried
If you spot the warning signs of suicide in someone you care about, you may wonder if its a good idea to say anything. What if youre wrong? What if the person gets angry? In such situations, it's natural to feel uncomfortable or afraid. But anyone who talks about suicide or shows other warning signs needs immediate helpthe sooner the better.
Talking to a person about suicide
Talking to a friend or family member about their suicidal thoughts and feelings can be extremely difficult for anyone. But if you're unsure whether someone is suicidal, the best way to find out is to ask. You can't make a person suicidal by showing that you care. In fact, giving a suicidal person the opportunity to express his or her feelings can provide relief from loneliness and pent-up negative feelings, and may prevent a suicide attempt.
Ways to start a conversation about suicide:
"I have been feeling concerned about you lately."
Questions you can ask:
"When did you begin feeling like this?"
What you can say that helps:
"You are not alone in this. Im here for you."
Tip 2: Respond quickly in a crisis
If a friend or family member tells you that he or she is thinking about death or suicide, it's important to evaluate the immediate danger the person is in. Those at the highest risk for suicide in the near future have a specific suicide PLAN, the MEANS to carry out the plan, a TIME SET for doing it, and an INTENTION to do it.
The following questions can help you assess the immediate risk for suicide:
Level of Suicide Risk
Low Some suicidal thoughts. No suicide plan. Says he or she won't attempt suicide.
If a suicide attempt seems imminent, call a local crisis center, dial 911, or take the person to an emergency room. Remove guns, drugs, knives, and other potentially lethal objects from the vicinity but do not, under any circumstances, leave a suicidal person alone.
Tip 3: Offer help and support
If a friend or family member is suicidal, the best way to help is by offering an empathetic, listening ear. Let your loved one know that he or she is not alone and that you care. Don't take responsibility, however, for making your loved one well. You can offer support, but you can't get better for a suicidal person. He or she has to make a personal commitment to recovery.
It takes a lot of courage to help someone who is suicidal. Witnessing a loved one dealing with thoughts about ending his or her own life can stir up many difficult emotions. As you're helping a suicidal person, don't forget to take care of yourself. Find someone that you trusta friend, family member, clergyman, or counselorto talk to about your feelings and get support of your own.
Helping a suicidal person:
Get professional help. Do everything in your power to get a suicidal person the help he or she needs. Call a crisis line for advice and referrals. Encourage the person to see a mental health professional, help locate a treatment facility, or take them to a doctor's appointment.
According to the U.S. Department of Health and Human Services, at least 90 percent of all people who die by suicide suffer from one or more mental disorders such as depression, bipolar disorder, schizophrenia, or alcoholism. Depression in particular plays a large role in suicide. The difficulty suicidal people have imagining a solution to their suffering is due in part to the distorted thinking caused by depression.
Common suicide risk factors include:
Suicide in teens and older adults
In addition to the general risk factors for suicide, both teenagers and older adults are at a higher risk of suicide.
Suicide in teens
Teenage suicide is a serious and growing problem. The teenage years can be emotionally turbulent and stressful. Teenagers face pressures to succeed and fit in. They may struggle with self-esteem issues, self-doubt, and feelings of alienation. For some, this leads to suicide. Depression is also a major risk factor for teen suicide.
Other risk factors for teenage suicide include:
Suicide in the elderly
The highest suicide rates of any age group occur among persons aged 65 years and older. One contributing factor is depression in the elderly that is undiagnosed and untreated.
Other risk factors for suicide in the elderly include:
Related HelpGuide articles
Resources and references
General information about suicide
Understanding Suicidal Thinking (16 page PDF) Learn about preventing suicide attempts and offering help and support. (Depression and Bipolar Support Alliance)
Coping after a suicide attempt
After an Attempt (PDF) Guide for taking care of a family member following a suicide attempt and treatment in an emergency room. (National Suicide Prevention Lifeline)
Why youth who
have a cell phone should know and memorize 741741
of Teaching Suicide Prevention in Schools
Unfortunately, however, most students are not adequately taught about suicide prevention in school or at home. This means that the majority of teenagers are unable to properly handle suicidal feelings.
Why Suicide Risk is High Among Teens
As many of us know, ones teenage years can be tumultuous. What many dont fully understand is what could lead teenagers to consider or attempt suicide. The answer to this, however, can be complex, and often involves both environmental and emotional factors.
How Suicide Prevention Programs in Schools Can Help
Proper access to resources is key to preventing and treating any disease, whether physical or mental. As previously stated, teenagers brains and bodies are still in development, and as such, they need guidance and counseling to properly cope with negative feelings, emotions, and situations.
Whether students are experiencing a poor home life or an undiagnosed mental illness, a suicide prevention program could help guide them in the right direction. Important aspects of any suicide prevention program should include:
With this knowledge, students and teachers alike can learn how to identify warning signs, whether within themselves or those around them. Once these signs are recognized, students and staff will have the skills and knowledge they need to reach out for help. When suicide prevention resources are enabled, the risk of suicide amongst teens will decrease.
Teens are a vulnerable population of
individuals and to maintain proper health, both physically
and mentally, they must be given the proper resources. By
adding suicide prevention to a schools curriculum,
students are better able to handle and address suicidal
thoughts or intentions. Prevention can save lives,
especially those of younger populations who are at higher
Suicide: Guidelines for Administrators and Crisis
Assembling a Crisis Team
A trained school safety and crisis response team is essential to being able to identify and intervene effectively with students who are at risk of suicidal behavior. At a minimum, the team should include an administrator, school-employed mental health professional, school security personnel, and other appropriate school personnel. Each crisis response team member needs to have clearly defined roles and responsibilities.
The crisis response team is responsible for developing and implementing suicide risk assessment, intervention and postvention policies and procedures. Sometimes these policies are developed at the district level by a district crisis response team.
The crisis response team should assign one or more individuals as a "designated reporter" to receive and act upon all reports from teachers, other staff and students about students who may be suicidal. This individual should be a school-employed mental health professional (e.g., school psychologist, counselor, nurse or social worker).
All school crisis response teams should have a representative from local law enforcement. If a student resists, becomes combative or attempts to flee, assistance from law enforcement is essential. In some jurisdictions, law enforcement can also be of help to obtain a "72-hour hold," which will place the youth in protective custody for psychiatric observation and treatment. In other jurisdictions, the community mental health center, child protective services, and/or calling 911 is required if the youth needs to be placed in protective custody and parents are unable to safely transport and/or are uncooperative. It is important to know the procedures for your jurisdiction.
All staff should receive training annually on the warning signs and referral procedures for students who display signs of suicidal thinking and behavior. Students should also receive instruction about risk factors, warning signs, and how to get help for themselves or a friend. This training can be part of the curriculum or a comprehensive suicide prevention program, but should be delivered by qualified credentialed educators.
Providing a safe, positive, and welcoming school climate; and ensuring that students have trusting relationships with adults serves is the foundation for effective suicide prevention efforts. Schools should have mental health supports that are explicitly connected to both school safety and learning outcomes. Ideally they also should implement a comprehensive empirically supported suicide prevention program [e.g., Signs of Suicide (SOS)]. Schools should make use of a well-publicized tip line for students to call or text with any concerns.
Bullying and suicide-related behaviors have a number of shared risk factors including mental health challenges (e.g., depression, hopelessness, and substance use/abuse). Thus, schools would be well served by adopting an integrated approach to violence prevention with both peer-directed and self-directed violence addressed in the design and implementation of programs, policies, and procedures. Youth who report frequently bullying others and those who report being frequently bullied are at increased risk for suicidal thoughts and behavior. Bully-victims (those who report both bullying others and being bullied) are at the highest risk for suicidal thoughts and behaviors. Keep in mind the relationship between bullying and suicide is more complex and less direct than it might appear. While bullying may be a precipitating event, there are often many other contributing factors, including underlying mental illness.
Prevention efforts should also address non-suicidal self-injury (NSSI or "cutting"). While the behavior is typically not associated with suicidal thinking, it is a red flag that someone is distressed and does increase the risk for suicidal thinking and behaviors. It is important that school staff learn to recognize the signs of NSSI, including cuts, burns, scratches, scabs, and scrapes, especially those that are recurrent and if explanations for the injuries are not credible. Suicide risk assessment should always be a part of intervention with the student who displays NSSI.
Identification and Intervention
Early identification and intervention are critical to preventing suicidal behavior. When school staff become aware of a student exhibiting potential suicidal behavior, they should immediately and escort the child to a member of the school's crisis response team for a suicide risk assessment (i.e., the "designated reporter"). They should not "send" the student on their own. If the appropriate staff is not available, 911 should be called. Typically, it is best to inform the student what you are going to do every step of the way. Solicit the student's assistance where appropriate. Under no circumstances should the student be allowed to leave school or be alone (even in the restroom). Reassure and supervise the student until a 24/7 caregiving resource (e.g., parent, mental health professional or law enforcement representative) can assume responsibility.
Designated members of the school crisis team should conduct a suicide risk assessment. The purpose of the assessment is to determine the level of risk and to identify the most appropriate actions to ensure the immediate and long-term safety and well-being of the student. This should be done by a team that includes a school-employed mental health professional.(See NASP's handout on ,a href="/resources-and-publications/resources/school-safety-and-crisis/preventing-youth-suicide/preventing-suicide-guidelines-for-administrators-and-crisis-teams#" >threat assessment for guidance on this topic.)
Caregiver notification is a vital part of suicide prevention. The appropriate caregiver(s) must always be contacted when signs of suicidal thinking and behavior are observed. Typically this is the student's parent(s); however, when child abuse is suspected protective services should be contacted. Even if a child is judged to be at low risk for suicidal behavior, schools may ask caregivers to sign a form to indicate that relevant information has been provided. Regardless, all caregiver notifications must be documented. Caregivers also provide critical information in determining level of risk. Whether a student is in imminent danger or not, it is strongly recommended that lethal means are (i.e. guns, poisons, medications, and sharp objects) are removed or made inaccessible.
Refer to community services if warranted. Suicidal thinking and behaviors can also occur outside of school hours. Thus, referral options to 24 hour community-based services should be identified in advance. It is best to obtain a release from the primary caregiver to facilitate the sharing of information between the school and community agency and it is highly recommended the school contact the agency to share critical information. School districts have an obligation to suggest agencies that are non-proprietary or offer sliding scale of fees.
Help the student to develop a safety plan. Generally speaking no-suicide contracts have been shown to be ineffective and are no longer recommended. However, helping the student to develop a written list of coping strategies and sources of support that can be of assistance when he or she is having thoughts of suicide (i.e., a safety plan) is recommended. Suicide prevention hotlines (e.g., 800-273-TALK), Crisis Text Line 741741 and the app MY3 (my3app.org) can be helpful elements of such a plan.
Schools are legally responsible for documenting every step in the assessment and intervention process. Such documentation ensures that protocols were followed. Every school district should develop a documentation form for support personnel and crisis response team members to record their suicide intervention actions and caregiver communication. Student information must be kept confidential but there are exceptions to FERPA when safety is of concern. Staff responsible for the safety and welfare of the student should be provided with the information necessary to work with the student and preserve the safety. School staff members do not need clinical information about the student or a detailed history of his or her suicidal risk or behavior. Discussion among staff should be restricted to the student's treatment and support needs.
Keep tabs on the rumor mill (including social media). If you hear or see something credible, refer the student to a school-employed mental health professional or crisis response team member. At the same time, gossip about particular incidents and students should also be discouraged. For more information on conducting a suicide intervention, see handout "A Suicide Intervention Model."
Following a suicide, school communities must strike a delicate balance. Students should have an opportunity to grieve, but in a way that does not glorifying, romanticizing or sensationalizing suicide, which may increase suicide risk for other students.
Confirm facts. Confirm the facts related to the death with the family and/or police. Inform other schools in the district with students related or close to the deceased. Contact the family to offer condolences, ask what the school can do to help, offer resources, and to discuss communication with the school community. Protect and gather the personal effects of the deceased for the family and/or the police. Pay close attention to other students (and staff) who may also be at risk of suicidal behavior.
Resources needed. In some situations, schools may have adequate resources to handle the aftermath of a suicide. However, it is critical that schools assess the impact of the suicide on the school community to determine the level of postvention support needed. Factors to consider include how well known the student was, if the suicide was public (i.e., occurred at school), and/or if the deceased had shared his/her suicidal intentions with others (particularly to large numbers of other students via social media). These factors generally increase the impact and thus the potential postvention needs of members of the school community.
Contagion. Suicide contagion occurs when suicidal behavior is imitated. The effect is strongest among adolescents: they appear to be more susceptible to imitative suicide than adults, largely because they may identify more readily with the behavior and qualities of their peers. Guilt, identification, and modeling are each thought to play a role in contagion. Sometimes suicide contagion can result in a cluster of suicides. Studies indicate that 1-5% of all suicides within this age group are due to contagion (100-200 teenage cluster suicides per year).
Suicide postvention strategies designed to minimize contagion include avoiding sensationalism or giving unnecessary attention to the suicide, avoiding glorifying or vilifying of suicide victims, and minimizing the amount of detail about the suicide shared with students.
If there appears to be contagion, school administrators should consider taking additional steps beyond the basic crisis response, including stepping up efforts to identify other students who may be at heightened risk of suicide, collaborating with community partners in a coordinated suicide prevention effort, and possibly bringing in outside experts.
Memorials. Memorials in particular run the risk of glamorizing suicide and should thus be implemented with great care. Living memorials are recommended such as making donations to a local crisis center, participating in an event that raises awareness about suicide prevention, or providing opportunities for service activities in the school that emphasize the importance of student's taking care of each other.
Care for the caregiver. It is important that administrators and crisis team members not underestimate the potential impact that a suicide can have on school staff members. School leaders should promote a culture in which both the students and the adults in the building feel comfortable asking for help and/or to take a break. Providing contact information and encouraging staff to meet their own mental health needs is an important first step in ensuring that staff are adequately supported.
Media. In general, news media
outlets will not cover suicide as a news story unless the
death occurs in public or the victim is a public figure. If
a suicide is reported by news media, reporters should simply
inform their audience of the death without sensationalizing
it. Pictures of the deceased and the use of the word suicide
in the headline are discouraged. News stories should note
that most people who die by suicide have mental health
challenges and exhibit warning signs, and these should be
included in the story or in a sidebar. Suicide should be
portrayed as a public health issue and the story should
offer both hope and information about available suicide
prevention and mental health resources available in the
Prevention Fresh With Classroom Activities
Each of the games requires the students participation, and encourages discussion. They teach students about the signs and symptoms of depression and suicidal ideation and the best ways to respond and do so in an engaging, non-threatening way.
Middle School: The Categories Game
This game takes about 30 minutes, and involves breaking up the class into groups of four to six students, and the task of the students is to determine what a list of things has in common. The facilitator will read a list with items such as:
These are all, of course, things you should not do when someone expresses symptoms of depression or suicidal thoughts. There are five different categories and each category has six lists, so there is enough to fill an entire 30-minute lesson block.
Middle School: Connections Game
This game is similar to Apples to Apples, and allows the facilitator to play the game as a whole class, or by breaking the class up into teams of four to six students. Students receive descriptor cards and the person in the group serving as the judge (or the class facilitator) chooses a noun card, and each of the players choose descriptor cards that they think matches best. For example, a facilitator may say the term text messages, and the students playing choose from their cards the most applicable descriptors that match the noun. The idea is that there are no right or wrong answers, but that the students defend their choice and explain how their descriptor matches the noun. This is a great way to encourage dialogue about the topics at hand.
Middle School: Lights, Camera, ACT
This game involves role playing and presents a selection of scenarios that students can act out. The goal of the exercise is to help students develop and practice effective ways to handle situations that involve being concerned for a depressed or suicidal friend. The implementation guide includes Dos and Donts to tell the students before the roleplaying, so that you start them off in the right direction. Below is one scenario.
Its the end of the school day, and Shawn is talking to Marcus about the upcoming weekend. They usually make plans to hang out and play basketball on Saturdays with some other guys, but Marcus hasnt shown up for the last couple months. Shawn asks Marcus about it, but he becomes annoyed and angry and tells him to just back off. Shawn thinks its strange considering Marcus is typically energetic, happy and always is always up for shooting hoops.
High School: Scripts for Suicide Prevention Hotline
These scripts are a really fun activity, and are especially helpful because students can really apply what is going on in their own community. After facilitators teach the students about the warning signs of depression and suicidal thoughts, and the ACT acronym (acknowledge, care, tell), pairs of students create scripts and talk out a call to a suicide prevention hotline. As your students hear the warning signs, its a great way to reinforce the lessons they have already learned.
High School: Myths and Facts Quiz
This quiz is very powerful and really challenges students beliefs about suicide and depression among teens. You can involve the students in any way you want, whether you discuss the myths and facts included in the implementers guide, or you pass out sheets and students read them and choose whether something is a myth or fact.
Of course, every
school and community is different. If you have an SOS
program and have any questions or comments about the games,
feel free to contact us at anytime at CBiggs@MentalHealthScreening.org.
Role of the School Board in Suicide Prevention
How can you, as a Board Member, assess your districts competence and readiness to deal with an ever-increasing population of students at risk for suicidal behaviors? Here are a few suggestions to get you started:
Check out your policies and procedures
How comprehensive are they- do they cover the range of suicide risk from ideation to attempts and completions?
When were they revised? Do they include incorporate current evidence-based standards of school suicide prevention?
When was the last time one of the district schools used the policy? Was there a formal evaluation of its effectiveness?
How often are local mental health referral resources reviewed? How effective is their collaboration with the district on at-risk students?
How up-to-date is your parental notification policy?
Do you have specific procedures for using web-based resources for parental notification in the event of sudden, traumatic death in the school?
Are there specific guidelines for interactions with the media? Do they incorporate Centers for Disease Control recommendations for suicide reporting?
Review suicide awareness training for faculty and staff
Is the training compliant with the two hour legislative mandate?
Who provides the training? Is it based on best practices or evidence based standards?
Is training available for ancillary staff- administrative staff, cafeteria and maintenance workers?
Is any type of training provided for bus drivers? Remember, they observe students in an informal setting and are often one of the best sources of information about student behavior
Finally, do your homework.
Review the data in your district. Find out how many suicide attempts have been reported over the last 3 to 5 years. Has there been a change over time? What is the profile of students who have made attempts? Are you noticing more attempts in younger students?
See what information this data gives you about your population of at-risk students. Familiarize yourself with current information about youth suicide risk. Check out recommended web-sites and stay on top of how this information relates to your schools and students.
the PDF Handout version of this
Announces National Plan for Suicide Prevention
If you want to contact the Surgeon
General about the Plan, here is his address: David Satcher,
MD, PhD, Surgeon General, 200 Independence Ave., SW.
Washington, DC 20201 The full plan can be found at this
Dr. Satcher and colleagues have set forth 11 goals with 68 measurable objectives to help reduce this number and save lives. He says, if we are successful, not only will it stop senseless deaths, but also will put on end to the harmful after-effects these acts have on families and communities. The program is the result of work done by advocates, clinicians, researchers and survivors. The program strives to change the most basic attitudes about suicide in an effort to change, the judicial, educations, social service, and health care systems.
Some of the objectives set forth include:
About half of the states have begun efforts to enact their own suicide prevention strategies.
We can't tear out a single page from