Dr. Thomas Simon
Dr. Thomas Simon is Associate Director for Science (ADS) within the Office of the Director of the Division of Violence Prevention (DVP) at the Centers for Disease Control and Prevention. Dr. Simon holds a Ph.D. in preventive medicine from the University of Southern California’s School of Medicine. During his more than 20-year career at the Centers for Disease Control and Prevention, Dr. Simon has served as a scientific advisor on multiple studies investigating suicidal behaviors and suicide prevention programs. He has also published more than 100 peer-reviewed articles, government papers and book chapters on these and related subjects.
Dr. Veronica Bloomfield
Dr. Veronica Bloomfield is a researcher and educator who teaches at Chapman University and California State University, Los Angeles. She holds a Ph.D. in Education from Chapman University. She is author and co-editor of LGBTQ Voices in Education.
Marni E. Fisher
Marni E. Fisher is a teacher, school administrator and teacher educator. She holds masters’ degrees in English and educational leadership. Fisher has 12 years of K-8 teaching experience and six years of experience working in school administration. She is also a teacher educator. She currently works with teachers in the College of Educational Studies at Chapman University. Fisher is a former junior editor for Teacher Education Journal and author and co-editor of LGBTQ Voices in Education.
Dr. Arielle Sheftall
Dr. Arielle Sheftall is a Postdoctoral Research Fellow in the Center for Suicide Prevention and Research at the Nationwide Children’s Hospital in Columbus, Ohio. Her research investigates decision making in relation to suicide risk in youth. Dr. Sheftall holds a Ph.D. in Human Development and Family Sciences from Ohio State University. Among other venues, Dr. Sheftall’s research has been published in the Journal of the American Medical Association: Pediatrics, the Journal of Child and Adolescent Psychopharmacology, and the Journal of Adolescent Health.
TEEN SUICIDE—A GROWING PROBLEM NATIONWIDE
Teen suicide is on the rise nationwide but preventing teen suicide remains a major challenge. In some communities, teen suicide rates have risen so drastically in recent years that the problem is now a recognized crisis—a crisis dire enough to call in support from the Centers for Disease Control and Prevention (CDC). This is the case in Palo Alto where over the past decade, Palo Alto’s two public high schools have reported suicide rates four times higher than the national average. Palo Alto’s recent cluster of teen suicides continues to garner substantial media attention and considerable speculation. Have Palo Alto’s high school students been overly influenced by social media? Or growing up in the vicinity of Stanford University where only 4.69% of undergraduate applicants are accepted, are Palo Alto’s youth simply under too much pressure to succeed at a young age? To date, there are no definitive answers. What we do know is that Palo Alto is not the only community currently asking difficult questions about preventing teen suicide.
Wealthy communities, like Palo Alto, are not alone when it comes to teen suicide. Some of the highest rates of suicide are found in the nation’s most economically impoverished regions. This includes a high percentage of American Indian and Native Alaskan communities. Indeed, the CDC reports that among American Indian and Alaska Native adolescents and young adults, ages 15 to 34, suicide rates are 1.5 times higher than national averages and 2.5% higher if one considers the numbers for males alone. Yet, as Dr. Arielle Sheftall, a researcher at the Center for Suicide Prevention and Research at the Nationwide Children’s Hospital observes, despite the fact that “Over the years, suicide rates in youth have increased drastically [particularly in rural areas], researchers are unsure what has caused this increase.”
There are few definitive answers about what causes teen suicide. What’s certain is that teen suicide is a nationwide problem, a problem plaguing communities rich and poor, and a problem that is on the rise. As reported in an April 2016 study released by the CDC, between 1999 and 2014, the suicide rate jumped from 0.5 to 1.5 (deaths per 100,000) for youth ages 10 to 14 and from 3.0 to 4.6 (deaths per 100,000) for youth ages 15 to 24. Notably, the suicide rate among girls ages 10 to 14 saw especially drastic increases during this period—it tripled, making girls ages 10 to 14 the most rapidly rising at-risk population. These sobering statistics leave only one question—what can and should we do in response?
This guide for educators, parents and teens brings together current data, interviews with experts, and practical advice on how to identify and intervene when a student, child or friend appears to be at risk of suicide. The goal is simple: to put this growing crisis into perspective and to provide everyone in the school community with the knowledge needed to help understand and more effectively respond to this growing crisis.
While working to eliminate suicide is the goal, through ToBecomeATeacher.org’s ongoing dialogues with educators across the United States, we know that educators and school administrators also want and need information on how to respond if and when a suicide occurs in their school communities. To be clear, knowing how to respond when a suicide occurs is also a critical part of any teen suicide prevention strategy. Why? Because there is a growing amount of evidence that suggests that teen suicides, unlike most adult suicides, often occur in clusters. For this reason, our guide includes specific information for educators and school administrators on what to say, what to do and who to contact if and when tragedy strikes, so that everything that happens in the aftermath of a tragedy is also informed by proven suicide prevention strategies.
If you or someone you know is at immediate risk of suicide, call 911 or the National Suicide Hotline at 1-800-273-TALK or 1-800-SUICIDE. If you know that someone is at risk of suicide, you can also intervene by bringing them to your local emergency room. Finally, you can reduce the risk of suicide by removing known risk factors in the immediate environment (e.g., guns, knives and drugs). Whatever you do, don’t leave someone at risk of suicide alone—stay with him or her and seek help.
TEEN SUICIDE BY THE NUMBERS
While numbers don’t tell the whole story, they can help put the current teen suicide problem into perspective:
|In the United States, suicide is the second leading cause of death among persons aged 10 to 24 years of age.||In 2012, suicide accounted for 5,178 deaths of people ages 10 to 24 nationwide.||The three most common forms of suicide are death by firearms, suffocation (including hanging), and poisoning (including drug overdose).|
|There is a strong indication that media coverage of teen suicides often leads to more suicides; for this reason, the CDC recommends that “Media coverage of suicide incidents and clusters should follow established guidelines to avoid exacerbating risk for ‘suicide contagion’ among vulnerable young persons.”|
|Young men are more at risk of suicide than young women; the CDE reports, “In 1994 rates were 15.7 per 100,000 among males compared with 2.7 among females. In 2012, rates were 11.9 among males compared with 3.2 among females.” However, between 2007 and 2012, there was a drastic increase in suicide rates among girls ages 10 to 14.||Suicide rates vary by race, ethnicity and location. Native American and Alaska Native youth are especially at risk. One 2007 study found that the suicide death rate among 15 to 19 year old American Indian/Alaska Native males was 2.5 times higher than the overall rate for males in the 15 to 19 year old age group.||Youth who identify (or are identified as) lesbian, gay, bisexual or transgender experience much higher rates of suicide; one study found that lesbian, gay and bisexual youth in grades 7 to 12 were more than twice as likely to have attempted suicide than their heterosexual peers; another study found that 25% of transgender youth have attempted suicide at some time.|
|Boys and young men are more likely to commit suicide with use of a firearm; girls and young women are more likely to commit suicide by suffocation.|
UNDERSTANDING TEEN DEPRESSION AND SUICIDE
The CDC defines depression as a condition “characterized by persistent sadness and sometimes irritability (particularly in children)” and suicide as “death caused by self-directed injurious behavior with an intent to die as a result of the behavior.” But understanding depression and suicide, especially in relation to teens, goes well beyond simple definitions. As Dr. Thomas Simon and his staff at the Centers for Disease Control and Prevention emphasize:
Suicide is a serious public health problem. At the CDC, we take a public health approach to addressing the problem, and we understand that risk factors for suicide exist at multiple levels of the social ecology—the individual, relationship, community, and society levels. While there are many factors at the relationship level of the social ecology (such as social problems with friends, family problems, lack of social connectedness) that put teens at risk for suicide, there are also problems at the individual level (e.g., impulsivity, mental health issues, family history of suicide), and the community and society levels (e.g., easy access to lethal means, the manner in which suicide is reported in the media) that can also contribute to teens’ suicidal thoughts and behaviors.
WHAT ARE THE KNOWN RISK FACTORS ASSOCIATED WITH TEEN SUICIDE?
A growing body of research, including research based on the analysis of large data sets, is helping researchers identify known risk factors associated with teen suicide. Yet, as Dr. Simon at the CDC emphasizes, “It is important to note that although several factors can put a young person at risk for suicide, having these risk factors does not always mean that suicidal behaviors will occur. Researchers agree that suicidal behavior results from an interaction of factors and is rarely the result of a single cause.” Thus, the known risk factors listed below should be understood as factors that are strongly correlated with but not necessarily indicative of an increased likelihood of suicidal ideation and attempts, especially when experienced on their own.
1.Peer and Family Problems
Like adults, young adults are unique. This means that different young adults are differently impacted by disappointments and changes in their immediate environment. For some young adults, for example, a close friend moving away or personal setback (e.g., not making the final cut on a team) may result in a temporary but not permanent period of sadness. For other teens, the same disappointments take on larger proportions and lead to full-fledged depressions and even suicidal thoughts and/or attempts.Similarly, although many young people bounce back from their parents’ separation or divorce with few or no lasting wounds, family breakdowns can be extremely difficult for some children and teens. This is largely due to the fact that family breakdowns are often accompanied by additional stressors, including increased exposure to violence, the introduction of new family members (e.g., when parents remarry and children are forced to welcome new partners and/or step siblings), and heightened financial difficulties. Again, while a family break up by no means puts a child or teen at risk of suicide, combined with other variables, family problems have been known to be a contributing factor to suicidal thoughts and attempts in some cases.
Dr. Arielle Sheftall observes that a history of suicide in the family may put a young person at particularly high risk: “The family may play a key role in a child’s vulnerability for suicidal behavior.” Indeed, as she emphasizes, “Research has shown that a parental history of suicidal behavior has been associated with a four to six-fold increased risk of suicidal behavior in their offspring and with a younger age of onset for first suicide attempt.” But other factors may also come into play, including household dysfunction, adverse childhood trauma, and lack of social support.
Substance abuse is associated with suicide on several levels. To begin, teens who are already depressed often turn to alcohol and/or drugs to numb their feelings of sadness. Excessive alcohol and drug use can also promote depression. In addition, substance abuse often promotes the risk-taking behaviors that lead to suicide attempts. In short, substance abuse—whether a cause or means—is strongly linked to teen suicide, and the link has been widely documented. As Dr. Elizabeth A. Schillings et al. concluded in their 2009 study, “Drinking alcohol while down conveyed a threefold increase in the risk of self-reported suicide attempts among youths not reporting suicidal ideation.” Specifically, Schillings and her colleagues found that:
Almost 18% of students who drank while down reported a suicide attempt in the past year, compared to only 3.1% of those who did not report drinking while down. The association between heavy episodic drinking and suicide attempts was statistically significant but of lesser magnitude: 8.8% of students who reported heavy episodic drinking reported a suicide attempt in the past year, compared to 3.3% of students who did not report heavy episodic drinking.
3.History of Depression or Mental Illness
The most known and least disputed factor contributing to teen suicide is a history of depression or mental illness. A 2009 study published in Current Opinions in Pediatrics reported “Psychological autopsy studies have shown a substantial link between clinical depression and suicide in adolescence with up to 60% of adolescent suicide victims having a depressive disorder at the time of death. Similarly, between 40-80% of adolescents meet diagnostic criteria for depression at the time of the attempt.” The study further observed, “Depression is the main predictor of suicidal ideation” and that “In clinically referred samples, up to 85% of patients with major depressive disorder (MDD) or dysthymia (i.e., chronic, but less severe depression) will have suicidal ideation, 32% will make a suicide attempt sometime during adolescence or young adulthood, 20% will make more than one attempt, and by young adulthood, 2.5% to 7% will commit suicide.”
4.Physical and Sexual Abuse/Dating Violence
Sexual abuse and dating violence are also strongly correlated with suicidal ideation and attempts. As reported by the RAINN (The Rape Abuse and Incest National Network), victims of rape are four times more likely to contemplate suicide. One recent study on dating violence discovered that “adolescent girls reporting recent dating violence were 60% more likely to report 1 or more suicide attempts in the past year.”The strong correlation between physical and sexual abuse, as well as dating violence is also recognized by the CDC. As Dr. Simon and his team told ToBecomeATeacher.org, “Given the strong links across the different forms of violence—child abuse and neglect, youth violence, intimate partner violence, sexual violence, elder abuse and suicidal behavior—the CDC has recently released Preventing Multiple Forms of Violence: A Strategic Vision for Connecting the Dots. This document provides background on the linkages and the need for a cross-cutting approach, and it describes the Division of Violence Prevention’s areas of strategic focus to better understand, respond to, and prevent violence across the lifespan.”
Bullying and cyber-bullying in their most extreme forms are a known cause of teen suicide. As reported by the National Center for Injury Prevention and Control:
We know that bullying behavior and suicide-related behavior are closely related. This means youth who report any involvement with bullying behavior are more likely to report high levels of suicide-related behavior than youth who do not report any involvement with bullying behavior. [And] we know enough about the relationship between bullying and suicide-related behavior to make evidence-based recommendations to improve prevention efforts.
We don’t know if bullying directly causes suicide-related behavior.
As writer, anti-bullying activist and educator Jodee Blanco explains, however, “When I do talks on bullying, I regularly meet kids who tell me that they are so desperate they want to take their own life. Talking about bullying, helping people understand the problem from a kid’s perspective, isn’t just public awareness—it’s about saving lives.” Blanco further emphasizes that bullies and bullies’ victims are at risk of suicide and that this is something that researchers and educators often fail to take into account.
Research suggests that LGBTQ youth are at least twice as likely as heterosexual youth to have suicidal thoughts. Some studies report that the attempted suicide rates of LGBTQ teens is nearly 5 times higher than it is for heterosexual teens. While these statistics may sound shocking, as Dr. Veronica Bloomfield, co-editor of LGBTQ Voices in Education explains, “there are multiple studies which confirm the disproportional rate of suicide among LGBT queue youth.” Bloomfield’s co-editor, Dr. Marni Fisher adds that despite the growing recognition of LGBTQ rights, including federal recognition of same-sex marriage, we have yet to see a reduction in suicidal behaviors and suicides among LGBTQ youth for several reasons: “The increase in LGBTQ visibility and rights does not change the teenage experience, which is a time of intense change. Also, these recent changes in visibility and rights require time to become integrated into society—integration doesn’t stop patterns of bullying, persecution, exclusion, or bigotry.”How bad is bullying for LGBTQ youth? The Gay Lesbian Straight Education Network 2013 national school climate survey reported “74.1% of LGBT students were verbally harassed (e.g., called names or threatened) in the past year because of their sexual orientation and 55.2% because of their gender expression.” The survey also found middle school students were more likely to be bullied based on their sexual orientation or gender identity than high school students, as were students attending religiously affiliated schools and students living in the South and Midwest.
Although eating disorders are often take up as a separate issue, in reality, the slow deaths of young women and men with severe eating disorders cannot be ignored when investigating the rising rates of teen suicide. A 2011 study published by the Journal of the American Medical Association, Psychiatry found that “Lifetime suicidality was associated with all subtypes of eating disorders” and that “Each eating disorder subtype was associated with significantly elevated levels of suicide ideation, while BN [bulimia nervosa] and SAN [subthreshold anorexia nervosa] were further associated with suicide plans and BN [bulimia nervosa] and BED [binge-eating disorder] were associated with suicide attempts.” Notably, the study also found that suicidality was most strongly associated with bulimia nervosa “as more than half of adolescents with BN reported suicide ideation and more than a third reported attempts.”
WHAT ARE “SUICIDE CLUSTERS”?
There is increasing evidence that teen suicide itself is also a known risk factor for teen suicide. The phenomenon, usually described as a “suicide cluster,” is defined by the CDC as “a group of suicides or suicide attempts, or both, that occurs closer together in time and space than would normally be expected in a given community.” Over the past two decades, a growing body of research has been published that supports the conclusion suicide clusters are especially and perhaps even uniquely prevalent among teens. In short, exposure to suicide among teens puts teens at greater risk of suicide. In fact, depending on the study, researchers suggests that teens exposed to suicide are anywhere from two to four times more likely to commit suicide.
In “Grief and Attitudes Toward Suicide in Peers Affected by a Cluster of Suicides as Adolescents,” a 2014 study published in Suicide and Life-Threatening Behavior, Caroline H. Abbott and Andrey L. Zakriski found that:
Abbott and Zakriski’s study compared groups with low and high exposure to suicide; their findings revealed a notable and significant contradiction:
Finally, Abbott and Zakriski emphasize that because there is a “negative correlation between exposure to suicide and belief in suicide prevention, it might be helpful to specifically target this belief in suicide prevention training and psychoeducation with adolescents affected by cluster suicides.”
For specific information on how to implement an effective response to a teen suicide and prevent any further suicide attempts or deaths, see What should educators do if a student commits suicide in their school community? in this guide.
WHAT ARE THE WARNING SIGNS OF TEEN SUICIDE?
Just as there is no single known risk factor that leads to teen suicide, there is no single factor or certain way to determine who is and is not at risk. Nevertheless, some behaviors are known to be more strongly correlated with teen suicidal ideation and attempts.
- 1.Social Withdrawal
Teens are social creatures. As such, social withdrawal (e.g., dropping off all school team or out of all school clubs, refusing to eat lunch with one’s peers and/or failing to show up at school events and weekend social gatherings), can be an indication that a teen is severely depressed and even at risk of suicide.
- 2.Changes in Quality of School Performance
A sudden and drastic drop in school performance, especially in a high achieving student, may be an indication that the student is giving up on their future and contemplating suicide. Bear in mind, however, that a sudden and drastic drop in school performance may also point to other factors, including substance abuse or problems at home.
- 3.Unusual Gift Giving and Giving Away Possessions
Giving away one’s cherished possessions whether it is a coveted collection, jewelry, money or electronics is often a sign that a teen is thinking about either running away or committing suicide.
- 4.Increased Use of Drugs and/or Alcohol
Drug and alcohol abuse can lead to suicide but also be a sign that a teen is at greater risk of a suicide attempt. Among other things, drug and alcohol abuse can lead to impulsive and risk-taking behavior and both are known to increase the likelihood of a suicide attempt.
- 5.Cutting and Other Forms of Self-harm
Self-harm can take many forms but cutting and piercing are the most common forms. A 2012 study published in the Journal of Environmental Research and Public Health reported: “Suicidal behaviors, that is self harm with the intent to die, is less prevalent than self-harm without the intent to die; however, the behaviors are complex and interrelated. An estimated 70% of adolescents who engage in repetitive self-harm also attempt suicide.”
- 6.Writing and Talking about Suicide
Although adults are advised to avoid jumping to conclusions, an excessive interest in suicide, especially in methods used to commit suicide, can be a sign that the teen is at-risk. While reading a book or watching a film about suicide is likely not cause for alarm, discovering that a teen is spending hours online watching instructional videos about how to hang oneself or overdose is cause for alarm.
WHAT CAN EDUCATORS DO TO PREVENT TEEN SUICIDE?
- 1.Understand the Warning Signs
While there are no definitive signs or sets of signs that necessarily point to suicide, educators are well advised to be on the look out for factors that increase the likelihood of suicide, including but not limited to:
- Behavioral issues and disorders (e.g., depressive disorders, substance abuse, anxiety and/or a history of self-injury, such as cutting).
- Personal characteristics (e.g., hopelessness or excessive talk of suicide).
- Stressful external circumstances (e.g., a disruptive home life, known history of sexual abuse or recent experience of loss, especially the loss of a sibling, best friend, parent or other caregiver).
Educators should also be aware of and prepared to intervene if and when they encounter any of the more overt warning signs:
- Suicidal threats (e.g., statements, such as “I’m going to kill myself”).
- Suicide notes and plans, including online postings.
- Prior suicidal attempts.
- Attempts to make final arrangements (e.g., attempts to write a will or give away one’s most precious possessions).
- An excessive preoccupation with death, dying and suicide.
- Exposure to suicide (e.g., the recent loss of a friend or sibling to suicide).
- 2.Learn to Ask Tough Questions and to Listen
If you have substantial reason to believe that a student is at risk of a suicide attempt, the National Association of School Psychologists advised that you take the following steps:
- Remain calm.
- Ask the youth directly if he or she is thinking about suicide.
- Express concern and listen to the youth.
- Reassure the youth that there is help.
- Provide constant supervision—do not leave the youth alone.
- Get assistance.
- 3.Be Prepared to Act and Know When and How to Do a Referral
Teachers and school administrators are often the first people to realize that a teen is at risk of suicide. While they are expected to listen, they are not expected to play the role of crisis counselor. As emphasized by the National Association of School Psychologists emphasizes that “No one should ever agree to keep a youth’s suicidal thoughts a secret” and furthermore, if and when a teacher confronts a student who is seriously contemplating suicide, they “should take the student to a school-employed mental health professional or administrator.”
- 4.Focus on Prevention In addition to helping guide children’s and teens’ decision making, however, educators can work to ensure their schools are places where bullying never happens. They can also work to ensure their schools are places that do not tolerate sexual violence and dating violence, which are both known risk factors for teen suicide. Finally, educators can work to create school environments free of other forms of discrimination, including discrimination based on sexual orientation and gender identity. As Marni Fisher emphasizes, “I would say that it is up to teachers to become part of the solution.” Fisher’s co-editor, Dr. Veronica Bloomfield agrees: “Many educators may have benevolent intentions, and do not mean to cause harm to students, but silently contribute to a culture that silences or disregards the experiences of LGBTQ students on campus.” Yet, Bloomfield further emphasizes: “There are educators who are advocates and allies for students and they help students by creating safe spaces on campus and by affirming students’ growth and development in ways that cannot be measured.”
5. Implement a Suicide Prevention Training Program
Dr. Arielle Sheftall emphasizes, “Intervention is key in order to prevent suicide and suicidal behavior among children and adolescents.” She notes that “There are a number of school-based interventions that have shown positive results in decreasing suicidal behavior in this age group.” The following are two programs Dr. Sheftall recommends for educators:
- Signs of Suicide (SOS) prevention program raises awareness of the problem of youth suicidal behavior and teaches educators how to recognize and act when someone is displaying warning signs.
- The American Foundation for Suicide Prevention (AFSP)’s Signs Matter: Early Detection program is an online program designed to educate teachers and school staff members from kindergarten through 12th grade on the signs associated with suicide risk, the typical behaviors presented in a school setting, and the necessary steps to take if signs are detected.
The best intervention is prevention, and on this account, there are many things that educators can do. As Dr. Arielle Sheftall observes, “In the field of suicidal behavior, decision-making deficits, problems with making decisions, have been associated with suicidal behavior in both adolescents and adults. It has been suggested that decision-making deficits have a stronger relationship to suicidal behavior versus suicidal ideation (thoughts) only.” For this reason, Dr. Sheftall emphasizes that “Helping children improve their decision-making skills may be an area where not only clinicians but teachers can intervene as well. Teaching children the steps associated with making informed decisions may help children when faced with extremely difficult situations where decisions need to be made sooner than later.”
WHAT SHOULD EDUCATORS DO IF A STUDENT COMMITS SUICIDE IN THEIR SCHOOL COMMUNITY?
No educator or school administrator wants to imagine responding to a suicide in their school community, but that is no reason to be unprepared for the possibility. Indeed, knowing how to respond appropriately is also a critical part of teen suicide prevention. After all, as already emphasized, unlike adult suicides, teen suicides often occur in clusters. In other words, one suicide in a school or broader community frequently leads to more teen suicides. Highly publicized teen suicides (e.g. those widely discussed in the media or social media) have also been known to result in spikes in teen suicides. This poses a difficult dilemma for teachers and school administrators grappling with a suicide in their school community: how to respond and celebrate the life lost without dwelling unnecessarily on the tragedy? Fortunately, there are steps teachers and principles and other members of the school community can take to ensure that tragedy doesn’t strike again.
- 1.Be Prepared by Designating a Suicide Response Coordinator and Response Team in Advance
Before a tragedy happens, it is important to designate who will take responsible if and when a suicide occurs in your school community.
Designate a spokesperson and back-up spokesperson: Taking this step will ensure that there is a fast and well coordinator response and that your school community sends out a unified and clear message to students, their parents, the local community and the media. Most importantly, there will be no lost time waiting for someone to take on the daunting role of being a school spoke person. Planning in advance also means that whoever has been designated to speak on behalf of your school will be someone whose had the training to handle this difficult role.
Designate other key members of your response team and a back-up for every critical role: Your school spokesperson is just one person on a much larger response team. Among other roles ensure you have also designated staff to cover the following behind the scenes tasks, including reaching out to the family of the deceased, coordinating with your district crisis team and breaking the news to students. Two of the most important roles will be working with the local media and monitoring the social media.*Review your school suicide response team at least once a year to ensure that everyone on your list is still part of your school community and that everyone on the list is still willing and able to take on the important role to which they have been designated. Ideally, you’ll never be forced to look at the list during an actual tragedy.
- 2.Contact Your Response Team
If a suicide occurs, contact your response team. If you can’t reach the first contact, contact the back up member on the list. Call together an emergency meeting of the response team members. Next, call an emergency staff meeting as your response team goes to work preparing to respond to the crisis.
- 3.Break the news to students
Breaking the news to the school community is an essential and difficult task. Whatever you do, do not issue a general announcement on your PA system. Likewise, do not ask all the students in the school to gather in the auditorium. Timing is also critical. Given the prevalence of social media, students will find out—some students may already know before staff do. It is critical to move quickly but also in a calm and methodical manner. Critical guidelines for breaking the news include the following:
- Ask known close friends to come to come to the office and inform them one-on-one.
- If the deceased student was on a team or club and close to many of the players or members, you may want to gather the team or club members together to deliver the announcement.
- Inform the remaining school community on a class-by-class basis. Be certain to provide teachers with a script.
- Give accurate information but only share the required information.
- Avoid discussing the method.
- Discourage comments that blame the victim.
- Address students’ feelings of responsibility.
- Encourage students to seek help and give them information on how to speak to a crisis counselor.
- 4.Control the Story in the Local Media
Naturally, the media will be interested in the suicide. Be prepared to make a statement but also have clear guidelines on how all school staff should handle media inquires and how all local media will be permitted to interact with the school community. Among other suggestions, schools are advised to do the following:
Ask your media spokesperson to prepare a written statement for release: The statement should acknowledge the death without giving details, express sympathy for survivors and outline the schools plan to deal with the aftermath (e.g., provide details about the fact that crisis counselors have been called in).Avoid speaking to the media: Direct front desk staff to take a message and then ask your school spokesperson to contact the media and ask that they leave the school alone to work through the tragedy.Do not permit media on school property: If the media are persistently and aggressively contacting students off school property, as your spokesperson to contact the media outlets in question and kindly request that they let students grieve out of the spotlight of the media.Do not let media attend any staff or parent meetings or school memorials. *The primary goal is to send out a clear statement to the media and then limit media attention as much as possible. This will best serve your students, staff, the broader school community and the grieving family.
- 5.Monitor the Social Media
After a school suicide, expect many students to express their grief online rather than in person. Of course, this poses another challenge. While one may be able to limit the number of spontaneous memorials that appear on one’s school property, controlling such memorials online will be difficult and even impossible. Among other responses, one may find that students have gone on to the deceased student’s Facebook page and started to leave comments and links (e.g., to images or videos featuring the student). Recognizing that the school will not be able to fully control the social media, it is still wise to have a designated member of the staff monitor the social media to limit and where necessary intervene (e.g., by asking a student to take down something they have posted that speculates on the reasons or details of the suicide).
- 6.Communicate with Families
Ask a designated staff member—ideally, a member of your school’s senior staff (principal, vice-principle or dean)—to send a brief note to families in your school acknowledging the death, expressing sympathy and detailing the school’s plan to address the crisis (e.g., how and when crisis counselors will be available to talk to students and even parents, since in some cases, other parents in your school community may have been close to the deceased student too).
- 7.Plan and Hold a Memorial
Teenagers can be extremely emotional. Rituals, such as memorials, are one way to help them manage their emotions and move forward. The challenge for educators faced with a suicide in their school community is typically not how to engage students in a memorial but rather how to control the scope of the memorialization. Some guidelines can help:
Limit spontaneous memorials: Students will likely create spontaneous memorials that include objects and notes; these should be discouraged and removed with notice if they do appear. These memorials can be upsetting and/or overly romanticize the death and subsequently encourage copycat incidents.
Avoid large assembles: Bringing together to many students at once can be too overwhelming. Also, don’t forget that while some students were close to the deceased, others were not; these groups need to work through the death in different ways.
Graduations: While you may choose to acknowledge the death at your school’s graduation, keep the acknowledgement short and move forward with the rest of the ceremony. Focus on the celebration at hand.
Funerals: Do not hold a funeral in the school and consult with the family about whether or not they wish to have a private or public funeral. In most cases, a memorial service, held after the funeral, is more appropriate for the family and for the students.
Memorials: Involve students in planning the memorial but also consult the family before making any final plans. Stay focused on remembering the deceased in a positive way and ensure the memorial does not become a venue for students to rehash the conditions of the death. As part of the memorial, you may also choose to create a community service component (e.g., a fundraiser) to help students grieve by feeling more in control of the situation.
- 8. Move Forward and Restore the Balance of Your School Community
It is naturally difficult to move forward and work towards restoring a school’s balance after a suicide, but this is a critical component of any school suicide prevention plan. Among other tasks, be prepared to:
- Assist and support vulnerable students, including close friends of the deceased.
- Assist and support siblings of the deceased who are still in your school community.
- Come up with a strategy to mark the anniversary of the student’s death without opening up old wounds.
WHAT CAN PARENTS DO TO PREVENT TEEN SUICIDE?
- 1.Respond When Depression and Anxiety First Appear
While it is important to avoid jumping to any conclusions when faced with a depressive teen, prolonged bouts of depression are often a sign that your teen is at risk of harming themselves. If your teen is exhibiting depressive behavior (e.g., they are emotionally and socially withdrawn, have abandoned their favorite pastimes and pursuits, have developed a substance abuse problem or eating disorder or are experiencing extreme stress or anxiety), reach out to them and check in. Of course, it is important to be empathetic rather than judgmental, and this holds true even if your teen is already in trouble (e.g., facing a court appearance or suspension from school). Don’t forget that teens who feel like their life is already out of control are even more likely to consider and follow through with suicide. As a parent, your job is to help your teen feel like they are in control or can regain control with the right conditions and support.
- 2.Be a Patient Listener
It may be difficult, but simply listening to your teen is the best thing you can do. Whether they are depressive or suicidal, listening is critical. If the messages they send out are at times accusatory or appear to be tangential and/or contradictory, remember than this is just how most tweens and teens communicate. As a growing body of evidence suggests, tweens’ and teens’ prefrontal cortexes continues to develop throughout adolescence, and this means that they frequently communicate in ways that can be confusing and difficult for adults to follow. As a parent, part of your job is to de-code these often confusing messages in order to get to the heart of the matter. Chances are this will take time and patience but when it comes to teen suicide prevention, you time and patience is also a matter of life and death.
- 3.Don’t Belittle or Dismiss Your Teen’s Talk of Suicide
Your teen’s stated reasons for being depressed may appear trivial to you but that doesn’t mean the reasons are trivial to them. It is especially important to avoid trivializing talk about suicide. If they are talking to you about suicide, even in what appears to be a joking manner, there is a strong likelihood that it is a cry for help.
- 4.Remove Known Risk Factors from the Home
If you have a strong reason to believe that your teen is at risk of suicide or you are living with a teen with a history of suicide attempts, it is important to remove known risks factors from your home, including the following:
- Prescription and over-the-counter medications: If you must have prescriptions and medications on hand, either lock them up or only maintain non-lethal dosages.
- Alcohol and drugs: Eliminate all alcohol and drugs from your home.
- Poisons: Lock up harmful common household products, including cleaners, any products containing alcohol, such as mouthwash, as well as potential fatal cosmetics, such as nail polish remover. In the United States, poisoning is the most common method of suicide among females.
- Guns: Remove all firearms from your home. In the United States, guns remain the most common cause of death in teen suicides and accounts for 56.9% of suicides among males.Remove all firearms from your home. In the United States, guns remain the most common cause of death in teen suicides and accounts for 56.9% of suicides among males. Notably, as Dr. Arielle Sheftall observes, “When it comes to the epidemiology of suicidal behavior, rates have been consistently higher in rural areas of the U.S. compared to urban areas. There have been a number of reasons given on why this is so and one reason that seems to be supported by the research is the availability of more lethal means in rural areas.”
- 5.Help Your Teen Find Help
Parents can help by knowing how to identify depressive and suicidal behaviors and by listening and reserving judgment, but parents are not expected to have all the answers. If you think your teen is at risk, consult a clinical psychologists, general medical practitioners, psychiatrists, and anyone else you trust and think can provide guidance. If you don’t have anyone to turn to in your immediate community or need help immediately, call 1-800-SUICIDE (784-2433) or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), and tell the counselor that you’re worried about child or teen. Remember, you don’t have to wait until a suicide attempt to reach out for help. In fact, the sooner you reach out for help and for answers, the better off your child will be.
WHAT CAN ADOLESCENTS DO TO PREVENT TEEN SUICIDE?
- Fight Against Bullying and Other Known Causes of Teen Suicide
Suicide impacts all types of students. In some cases, students who commit suicide appear to be the happiest and most popular kids in the school. However, we also know that some students are more at risk of thinking about, attempting and following through with suicide than others.Bullying, cyber-bullying and identity-based harassment (e.g., homophobic harassment) have been identified as factors that increase one’s risk of suicide. By working to create a school environment free of bullying and harassment of all kinds, you can help, if not eliminate, at least some of the risk factors that are known to put students at risk of suicide. To get started, also see the following ToBecomeATeacher.org’s guides: Preventing Bullying and Cyber-bullying and Sexual Assault Prevention in Schools.
- Know How to Identify the Signs
Teenagers are often depressed, but depression doesn’t necessarily mean someone is suicidal. However, if you have a friend who is depressed and exhibiting other symptoms (e.g., they have started to give away items of value or to talk excessively about suicide), reach out and offer to help them find help. Do not try to become their personal counselor. You can listen and support your friend but counseling someone who is seriously considering suicide is a job best left to a trained professional.
- Encourage Your Friends to Talk to a Trusted Adult or Call a Suicide Prevention Hotline
If you’re truly concerned, encourage your friend to talk to a trusted adult (e.g., a parent, guidance counselor, teacher or coach). If a suicide attempt seems imminent, encourage them to call 1-800-SUICIDE (784-2433) or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
- American Academy of Child & Adolescent Psychiatry—Teen Suicide
- American Foundation of Suicide Prevention
- Centers for Disease Control and Prevention—Suicide Prevention Resources
- National Institute of Mental Health—Suicide Prevention
- Preventing Youth Suicide—National Association of School Psychologists
- Society for the Prevention of Teen Suicide
- Substance Abuse and Mental Health Services Administration
- Suicide Prevention Resource Center
- The Trevor Project
1. Stav Ziz, “After Rash of Teen Suicides in Palo Alto, the CDC Sends Team to Investigate,” Newsweek, 16 Feb. 2016, http://www.newsweek.com/after-rash-teen-suicides-palo-alto-cdc-sends-team-investigate-427383
2. See among other recent articles, Hanna Rosin’s late 2015 feature article, “The Silicon Valley Suicides,” in The Atlantic, http://www.theatlantic.com/magazine/archive/ 2015/12/the-silicon-valley-suicides/413140/
3. Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS), Available from http://www.cdc.gov/injury/wisqars/index.html.
4. Dr. Arielle Sheftall, Interview with Cait Etherington, May 2016.
5. Sally C. Curtin, Margaret Warner, and Holly Hedegaard, “Increase in Suicide in the United States 1999 to 2014,” Centers for Disease Control, Press release, April 2016.
6. Statistics for this section were compiled from the following sources: Centers for Disease Control and Prevention, “Suicide Trends Among Persons Aged 10–24 Years—United States, 1994–2012” (March 6, 2015, 64(08)); U.S. Department of Health and Services, Substance Abuse and Mental Health Services Administration Center for Mental Health Services, Preventing Suicide: A Toolkit for High Schools (2012); S.T. Russell and K. Joyner, “Adolescent sexual orientation and suicide risk: Evidence from a national study,” American Journal of Public Health (2001, 91: 1276–1281); and A.H. Grossman and A.R. D’Augelli, “Transgender youth and life-threatening behaviors,” Suicide and Life-threatening Behavior (2007, 37: 527-537).
7. Centers for Disease Control, “Depression,” http://www.cdc.gov/mentalhealth/ basics/mental-illness/depression.htm
8. Centers for Disease Control, “Suicide,” http://www.cdc.gov/violenceprevention/ suicide/definitions.html
9. Dr. Thomas Simon and the Centers for Disease Control and Prevention research staff, Interview with Cait Etherington, May 2016.
10. For more information, see on the CDC’s “social-ecological” approach to understanding suicide, see The Social-Ecological Model: A Framework for Prevention, http://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html.
11. Dr. Thomas Simon and the Centers for Disease Control and Prevention research staff, Interview with Cait Etherington, May 2016.
12. Dr. Arielle Sheftall, Interview with Cait Etherington, May 2016.
13. Dr. Elizabeth A. Schilling et al., “Adolescent Alcohol Use, Suicidal Ideation, and Suicide Attempts,” Journal of Adolescent Health (2009, 44: 338).
14. Scottye J. Cash and Jeffrey A. Bridge, “Epidemiology of Youth Suicide and Suicidal Behavior,” Current Opinion in Pediatrics (October 2009, 21(5): 613-619).
15. RAINN, “Who are the Victims,” https://rainn.org/get-information/statistics/sexual-assault-victims
16. Elyse Olshen, “Dating Violence, Sexual Assault, and Suicide Attempts Among Urban Teenagers,” Archives of Pediatrics and Adolescent Medicine (June 2007, 161: 543).
17. Dr. Thomas Simon and the Centers for Disease Control and Prevention research staff, Interview with Cait Etherington, May 2016.
18. National Center for Injury and Prevention Control, The Relationship Between Bullying and Suicide: What We Know and What it Means for Schools, http://www.cdc.gov/violence prevention/pdf/bullying-suicide-translation-final-a.pdf
19. ToBecomeATeacher.org, “Preventing Bullying and Cyber-bullying,” http://tobecomeateacher.org/preventing-bullying-cyber-bullying/
20. Dr. Veronica Bloomfield, Interview with Cait Etheringthon, May 2016.
21. Marni Fisher, Interview with Cait Etheringthon, May 2016.
22. Gay Lesbian Straight Education Network (GLSEN), 2013 National School Climate Survey, http://www.glsen.org/learn/research/national-school-climate-survey
23. Sonja A. Swanson et al., Prevalence and Correlates of Eating Disorders in Adolescents, Journal of American Medicine Association, Psychiatry (July 7, 2011, 68(7): 717-718).
24. Madelyn Gould et al., “Suicide Clusters: An Examination of Age-specific Effects,” American Journal of Public Health (1990, 80: 211-212).
26. Caroline H. Abbott and Andrey L. Zakriski, “Grief and Attitudes Toward Suicide in Peers Affected by a Cluster of Suicides as Adolescents,” Suicide and Life-Threatening Behavior (2014: 1-14).
28. Monica H. Swahn, “Self-Harm and Suicide Attempts among High-Risk, Urban Youth in the U.S.: Shared and Unique Risk and Protective Factors,” International Journal of Environmental Research and Public Health (2012, 9: 178-191).
29. National Association of School Psychologists, Preventing Teen Suicide: Tips for Parents and Educators, https://www.nasponline.org/resources-and-publications/resources/ school-safety-and-crisis/preventing-youth-suicide/preventing-youth-suicide-tips-for-parents-and-educators
30. Dr. Arielle Sheftall, Interview with Cait Etheringthon, May 2016.
31. Marni Fisher, Interview with Cait Etheringthon, May 2016.
32. Dr. Veronica Bloomfield, Interview with Cait Etheringthon, May 2016.
33. This section of ToBecomeATeacher.org’s guide is adapted from the following sources: AFSP. After a suicide: A toolkit for schools. Newton, MA: Education Development Center, Inc. Available online at http://www.sprc.org/sites/sprc.org/files/library/ AfteraSuicideToolkitforSchools.pdf; M. Kerr et al., Postvention standards manual: A guide for a school’s response in the aftermath of sudden death (4th ed.). Pittsburgh: University of Pittsburgh/Western Psychiatric Institute and Clinic, 2003; and U.S. Department of Health and Services, Substance Abuse and Mental Health Services Administration Center for Mental Health Services, Preventing Suicide: A Toolkit for High Schools (2012).
34. Centers for Disease Control and Prevention, Suicide Facts at a Glance 2015, www.cdc.gov/…/suicide-datasheet-a.pdf
36. Dr. Arielle Sheftall, Interview with Cait Etherington, May 2016.