Crisis Management

Checking In

Suicide is Personal

Many of us are survivors,

who miss our friends and relativesSome may be attempt survivorsPlease take care of yourself during this training!

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DefinitionsSuicide-Self-injury with the intent to

cause deathWorld Health Organization

Survivor-Those left behind (families, friends, etc.)

Contagion- suicidal behavior is imitated by one or more individuals following the awareness of a recent threat, attempt, or completion

Oklahoma2010 - 618 suicide deaths – 13th highest Oklahoma’s =16.5 U.S. = 12.4 (1)

Suicide and Homicide Statistics (2004-2009) (2)

• 3,203 deaths by suicide were reported• 1,322 homicides

• On average 534 die by suicide annually• On average 220 deaths by homicide

annually

1.) American Foundation for Suicide Prevention http://www.afsp.org/index.cfm?fuseaction=home.viewPage&page_id=05114FBE-E445-7831-F0C1494E2FADB8EA2.) Summary of Violent Deaths in Oklahoma; Oklahoma Violent Death Reporting System, 2004-2009

Oklahoma

• Suicide rates highest in the 25-64 age group

• 79% of suicide victims are male, 21% are female

• The rate of suicide completion is higher for males than females across all categories of race and age.

• Overall rate for males increased 12% from 22.3 in 2004 to 25 in 2009 (2% annual increase)

• Male suicide rates increased 27% among persons 45-64 and 22% among persons 25-44 (5% and 4% average annual increases respectively)

Summary of Violent Deaths in Oklahoma; Oklahoma Violent Death Reporting System, 2004-2009

Oklahoma

Of those that lost their lives to suicide, 23% served in the US Armed Forces.

Suicide rate among veterans 65 years and older decreased 27%, while the suicide rate among veterans 35-44 increased 67%.

Firearms (60%), hanging/strangulation (19%), poisoning (18%).

Summary of Violent Deaths in Oklahoma; Oklahoma Violent Death

Reporting System, 2004-2009

Second leading cause of death among youth in Oklahoma.

One out of 53 high school students (1.9 percent) reported having made a suicide attempt that was serious enough to be treated by a doctor (Nationally).

For each suicide death -100–200 suicide attempts.

1 out of every 15 high school students attempts suicide each year.

CDC, 2010a

Proving the Case for Prevention

Second leading cause of death among youth in Oklahoma.

One out of 53 high school students (1.9 percent) reported having made a suicide attempt that was serious enough to be treated by a doctor (Nationally)

For each suicide death -100–200 suicide attempts

1 out of every 15 high school students attempts suicide each year

CDC, 2010a

Proving the Case in our Schools

Power of Words

Consideration

• Adult Attitudes

• Youth Attitudes

• It is all about getting those to help

Suggested DialogueSay this Not this

• We often wonder why someone would take their life, we know they must have been in a lot of pain

• Suicide is a selfish decision

• When people are stressed, hurt, or depressed they only know they want the pain to stop

• He/she made a bad decision

Always be mindful those around you may have lost someone to suicide and may have attempted.

Connections Perceptions of friendships Church Neighborhoods Organizations Clubs Sports

13

Adolescent “Triggers”

LossChangeTrouble

After An Event Gatekeeper trainings for adults National Suicide Prevention Lifeline

placement Office box Debriefing Community small trainings Support groups Extra mental health supports

Crisis Management Preparation to Deal effectively with multiple pressures from

various sources Specific detailed plan Uniqueness of each event Provide management of information to the

community Avert contagions

Team Preparation All members trained in a gatekeeper training Members trauma trained Schedule initial meeting to develop plan Schedule quarterly meetings Revisit policies Update resources Revise/develop referral protocols Commitment of team Ensure annual gatekeeper trainings for key staff

including staff resources how to talk with youth about suicide

Role Possibilities Administration Team leader Information coordinator Parent Liaison Administrative Liaison Student Wellness Coordinator Operations Coordinator Faculty Support Coordinator Community Liaison Student Crisis Assessment Team for those at risk

(referrals, parent meetings, etc.) Back ups for each position

Crisis ResponseThe Crisis Response Team Ten to 15 people chosen for their skills, credentials,

and ability to work compassionately and effectively under pressure—

Administrators Counselors Social workers Psychologists Nurses School resource officers Faith community Local law enforcement

Crisis Response Checklist Confirm death/Inform the school superintendent Contact the deceased’s family to offer condolences,

inquire what the school can do Call an immediate meeting of the Crisis Response

Team Immediately notify faculty and staff of the death

(usually phone or e-mail). Schedule all-staff meeting ASAP Notify students in first hour class Prepare script to be delivered by first hour teacher

(get replacement for teachers not able to make announcement)

Decide who will follow the deceased person’s schedule

Crisis Response ChecklistOperations Assign a staff to follow the deceased student’s schedule Arrange for several substitute teachers or “floaters”

from other schools Arrange for care stations, for staff and students. Provide tissues and water throughout the building Watch the school environment Prepare to track and respond to student and/or family

requests for memorialization.

Community PartnersCoroner/medical examinerPoliceMayor’s office/local governmentMental health and medical communitiesGrief support organizations, to plan for service

needsArranging for outside trauma responders

Crisis Response ChecklistFuneral Communicate logistics, including the need for crisis

counselors and/or security to be present at the funeral.

Importance of communicating with clergy, contagion, etc.

Keep school open if the funeral is during school hours Back up staff at school Arrange for counselors/school staff to attend the

funeral. Encourage parents to accompany their child to the

funeral. Team staff to be present at funeral home during

visitation.

Crisis Response ChecklistMedia Relations Prepare a media statement. Designate a sole media spokesperson Advise students to avoid interviews with the

media. Refer media outlets to Reporting on Suicide:

Recommendations for the Media.Social Media Oversee school’s use of social media as part

of the crisis response. Convene a small group of students to work

with school administration to monitor social networking sites and other social media.

Crisis Response Checklist Draft death notification statement for parents,

including resources. Provide handouts on Facts About Suicide and

Mental Disorders in Adolescents and Talking About Suicide to faculty.

Crisis team debrief every day Care stations for students (time period) Announce care stations hours and locations Ask for outside help Send letter to parents Ensure letter is also placed on the webpage Monitor social media

Crisis Response ChecklistSafety Keep to regular school hours. Ensure that students follow established dismissal

procedures. Call on school resource officers to assist parents and

others. Pay attention to students who are having particular

difficulty

First day(called special faculty meeting) Allow at least one hour to address the following goals: Introduce Team Share accurate information Allow staff to express their own reactions and grief. Provide scripted death notification Prepare for student reactions and questions by

providing handouts to staff on Talking About Suicide and Facts About Suicide and Mental Disorders in Adolescents.

Explain plans for the day, including locations of care rooms.

School climate-changes in behavior among the students

Brief staff on referral process Apprise staff of any outside responders. Remind staff to allow students to go to the care

stations Remind staff of student dismissal protocol for funeral.

End of first day

Hold all staff debrief Offer verbal appreciation of the staff. Review the day’s challenges and successes. Debrief, share experiences, express concerns, and

ask questions. Disseminate information regarding the death and/or

funeral arrangements. Discuss plans for the next day. Self-care. Avoid tests

Get the Facts First Confirm the death. (Principal or ?)

If the Cause of Death Is UnconfirmedRumors-harmful for everyone

Family may not want it labeled a suicideStudents may already be talking

Administration to talk/consult with the family

Team Leader

Team Leader Makes team assignments Coordinate with administration Schedules debriefings Schedules breaks Maintains documents and protocols Leads faculty meetings/debrieings

Information Provides media statements or coordinates with

district assigned media spokesperson Provides media with best practices for reporting Checks with families about facts and their wishes Provides information about funerals, etc. Determines level of information and message youth

receive Provides script to be given to youth via their first

hour teacher Maintains media files Provides best practices for social media messages,

youth discussions, parent prevention strategies for media

Ensures the 800-273-Talk number is posted in schools, scrolling messages, etc.

“The family has requested that information about the cause of death not be shared at this time”

“We know there has been a lot of talk about whether this was a suicide death. Since the subject of suicide has been raised, we want to take this opportunity to give you accurate information about suicide in general, ways to prevent it, and how to get help if you or someone you know is feeling depressed or may be suicidal.”

Emergency Faculty Meeting First thing after the death Relay family wishes Introduce people who will be in the building Explain front office staff roles for the next few

days Provide staff with referral procedures Introduce locations of Care Stations Provide staff with script Provide them with agenda for the first day

after the suicide(traumatic death) Ensure all missing school staff receive

information SELF CARE…. Provide end of school debrief

Parent Liaison

Provides resources, materials for parents

Answers inquiries from parents Host parent meetings Provides resources for parents on the

school web page (access number, materials discussing grief and how to help your child)

Providing take home letters

Coordinator of student care stations manages logistics of locations, staffing,

and protocol for dismissing students to care stations

Community Liaison informs relevant community agencies of

the school’s plans; arranges for community volunteers to

augment school team if necessary contacts off-campus referral resources

to alert them to potential referrals Reaches out to clergy

Physical Logistics Coordinator Addresses all issues that affect the

physical school building Arranges facility setups for meetings Deals with extended school hours,

evening meetings

Faculty Support Coordinator at least two members follow the daily

schedule of the deceased and siblings; are available to

answer faculty questions; provide support to the faculty

if not done by community team member

Community Events Smaller groups more favorable Recent unseen wounds Freedom to disclose

Critical Climate Oversight two or more members of the team

coordinate crisis contacts with vulnerable students

Administrative Liaison Distributes scripts for phone responses

and directs staff Who answer phones; distributes

information to faculty Coordinates meeting room and faculty

support room assignments manages rumors

Helping Students CopeKEY CONSIDERATIONS Emotional regulation - a person’s ability to express

intense emotions such as grief and fear. Adolescents have mastered basic skills

encountered daily Challenged in the face of a suicideComplex feelings - physical indicators (stomach upset, restlessness, or insomnia)Increased risk for difficulties with emotional

regulation Opportunities to express their emotions Meetings with Students in Small Groups Adjust the regular academic schedule. Have counselors go into the classrooms to give

students accurate information about suicide Provide safe reporting

Helping Students Cope Help Students Identify and Express Their Emotions Emotional expression-anger, humor, silence, etc.

What is your biggest concern about the I immediate future?

What would help you feel safer right now?

Practical Coping Strategies simple relaxation, such as taking three deep slow breaths engaging in favorite activities or hobbies exercising reminding themselves that they can use coping skills list people they can turn to list things they’re looking forward to focusing on individual goals Students should also be encouraged to think about how

they want to remember their friend.

Working with the Community Suicide happens in communities, not just in

schools Engage mental health providers Coroner/Medical Examiner Faith community Media-Educate the community about the

causes and complexity of suicide and to identify available mental health resources.

Law Enforcement First Responders-EMT Funeral directors SOS groups

Memorialization All deaths the same way-alleviate stigma Contagion Funerals School newspapers Desks/ lockers/uniforms Events Permanent memorials/scholarships (for everyone,

forever?) Graduation Memorials

t-shirtsyearbook adscandle light vigils (ongoing)

Creative ideasOut of Darkness Walksa day of community serviceVolunteering on crisis lineSuicide awareness campaign

Social Media Involve Students Disseminate Information Schools website and/or an online

presence The funeral or memorial service Where students can go for help or meet

with counselors Resource numbers 800-273-TALK

Suicide Contagion What is it? How do you prevent it? Identifying Other Students at Possible Risk for Suicide Of special concern are those students who:

-have a history of suicide attempts-are dealing with stressful life events such as a death

or divorce in the family-were eyewitnesses to the death-are family members or close friends of the deceased -received a phone call, text, or other communication from the deceased foretelling the suicide-may have fought with or bullied the deceased

Encourage screenings for those at heightened risk by using a mental health screening

Connect with Mental Health providers Monitor media coverage

Bringing in Outside Help Build a local coalition-toolkit

National Emergency Assistance Team of the National Association of School Psychologists http://www.nasponline.org/resources/crisis_safety/neat.aspx

The Dougy Center: National Center for Grieving Children & Families http://www.dougy.org

Riverside Trauma Center http://www.riversidetraumacenter.org

Boston Children’s Foundation http://www.bostoncf.org

Going Forward Lifeline’s programs

Suicide awareness programs to educate teachers and other school personnel

Programs to educate students themselves about depression, anxiety, substance abuse, and conduct disorder

Gatekeeper training programs, which teach practical skills

Best Practices Registry for Suicide Prevention (BPR), maintained by SPRC and AFSP and available at http://www.sprc.org.

Another source is the National Registry of Evidence-Based Programs at http://www.nrepp.samhsa.gov.

Creating school strategies

General Considerations• Treat All student deaths in the same way.

Why? Stigma, family, friends

• Schools should be aware that adolescents are vulnerable to the risk of suicide contagion.

Why? Glamorization, Copy cat

• The student who died by suicide was likely struggling with a mental anguish.

? You cannot always see what may be happening-substance abuse, anxiety, etc.

• Help is available for any studentWhy? Although we may think everyone is ok, we never know what the event may have triggered.

ResourcesNational Suicide Prevention Lifeline

800-273-TALK

ODMHSAS405-522-3835

www.odmhsas.org

Resource Centerhttp://ok.gov/odmhsas/Prevention_/

E-Prevention_Resource_Center/index.html

After a School Suicidehttp://ok.gov/odmhsas/Prevention_/

Prevention_Initiatives/Youth_Suicide_Prevention_and_Early_Intervention_Initiative/index.html

Tom Thomson405-522-3908

tthomson@odmhsas.orgAccess Specialist

For additional questions

Tracy McKeown MPH405-419-4142

Tracy_mckeown@occhd.org

Julie Geddes405-522-3835

jgeddes@odmhsas.org