youth suicidal behavior and postvention · 2018. 11. 27. · bullying prevention **coping...

James Mazza, Ph.D.University of Washington

19th Annual Suicide Prevention Conference

Provo, Utah: December 3, 2018

Youth Suicidal Behavior and Postvention

Disclosure Statement:

I am the first author of the DBT Skills in Schools book. My wife is the second author. We receive royalties on the sale of the books.

Guilford Press, INC


Program Objectives:

1. To learn the different components of FACTS & LEARN.

2. To recognize the different levels of prevention and intervention for youth regarding suicidal behavior.

3. To learn and identify different intervention and postvention strategies.

4. To determine what postvention strategies make sense for your current setting.


FeelingsActionsChanges Threats SituationsFACTS acronym adapted from Lifelines suicide prevention curriculum by Hazelden http://www.hazelden.org/web/public/lifelines.page

FACTS

Do not reproduce or distribute w ithout w ritten permission from James J. Mazza © Mazza Consulting, 2018


• Hopeless• Depressed• Angry• Lonely• Burdensome• Anxious• Trapped• Lacking purpose• Guilty• Desperate



• Abusing alcohol/drugs• Reckless behavior• Aggression/fighting • Self-harm/cutting• Giving away possessions



• Personality• Behavior• Academic performance• Sleep patterns• Eating habits• Losing interest in social activities, sports, hobbies• Withdrawing from family and friends • Not taking care of personal appearance • Sudden improvement after seeming depressed

for a long time



Talking about death “Who do you think would attend

my funeral?”

Concerning statements “You’ll miss me when I’m gone” “I can’t take this anymore”

Making plans for suicide◦ Researching suicide methods online◦ Obtaining lethal means (e.g. buying

rope)

Threats can appear◦ Verbally ◦ In writing: text, social media, etc. ◦ In actions: making a suicide plan



• Mental health or substance use disorder • Recent losses: relationship, job, death of a

loved one• Rejection: from academic program, sports

team, romantic partner, etc. • Getting into trouble• Changing circumstances: moving, graduating,

changing schools• Life situations: abuse, pregnancy, intimate

dating violence • Suicide exposure: suicide attempt or death of

a friend or family member



Look for warning signsEmpathizeAsk about suicideRestrict lethal meansNext level of care

LEARN



Feelings of depression, anxious, hopelessness, feelings of being out of control

Actions: abusing alcohol/drugs, self-harm, previous suicidal behavior

Changes: sudden changes in behavior, relationships, elation from deep sadness, can go in both directions

Threats: talking about death, concerning statements, making plans for suicide, making threats (verbally, social media, etc)

Situation: recent loss of a relationship or loved one, mental health issues, rejection from a team or relationship, major life event, getting into trouble

D d di ib i h i i i f J J M © M C l i 2016


“I am concerned about you and what maybe going on”

“I am not here to judge, I just want to help and listen” “I really care about you. I want to help.” “You mean a lot to me and I’m worried about you.”



Sometimes when people are ________, ________, and ________, they are thinking about suicide. Are you thinking about suicide?



“Do you have access to a gun?” “who can hold onto your gun for you? Lets make that

happen” “where can you store the ammunition in a safe place?”

“Do you have access to pills and/or alcohol?” “Who can help you remove these from you home? Lets

make that happen”



Talk to your school psychologist, counselor, social worker, or nurse

Call the National Suicide Prevention Lifeline: 1-800-273-8255 (TALK)

Trevor Line (LGBT): 1-866-488-7386 Crisis Chat www.crisischat.org Crisis Text www.crisistextline.org



http://www.crisischat.org/

http://www.crisistextline.org/

Components for Reducing Suicidal Behavior

Prevention

Intervention

Postvention


Upstream Strategies for Suicide Prevention

Prevention: The process of trying to reduce the likelihood of students/youth experiencing any suicidal behavior. Universal level. Good suicide prevention programs do not need to

necessarily focus on suicide Drug and Alcohol Prevention Risky Sex Bullying Prevention **Coping strategies and decision-making


** Note: Explored in detail during morning breakout sessions


Intervention: The process of trying to reduce the severity and/or emotional distress that is contributing to students/youth experiencing any suicidal behavior. Selective & Indicated levels. These programs address warning signs, myths and

teach good listening skills ASIST – Applied Suicide Intervention Skills Training QPR – Question, Persuade, and Refer SOS – Signs of Suicide RY – Reconnecting Youth



Postvention: The process of intervening after the death of a suicide to prevent possible contagion effects (i.e., additional suicides), thus, suicide postvention is also a form of suicide prevention. Because of its preventive focus postvention procedures are viewed as a critical and essential element of school-based suicide prevention.


Postvention –1st Day before school starts1. Implement School Crisis Plan – use calling tree to contact all school personnel.

2. Set up school personnel meeting for early the next day before school starts. Go over procedures on how the school will function, resources available to students & staff, and how this information will be disseminated: small groups recommended.

3. School needs to focus on feelings and emotion rather than academics – otherwise school will be viewed as not caring.

4. Provide opportunities for school personnel to vent their feelings and frustrations before the school day starts and before they have to deal with the emotions of their students.

5. Provide a written announcement for teacher regarding the death of the student: facts and school & community resources.


Postvention – 1st Day School Starts

1. Announcement regarding the death of the student should occur at the same time. Teachers should read the provided sheet. Principal should use the PA system to inform teachers when they should read their announcements.

2. Within the classrooms, teachers should provide students with the facts, resources available today, and the school day structure.

3. Let students talk about their feelings. Important to emphasize that no one is to blame. The person with all the answers is unfortunately no longer with us.

4. Offer support to the family and work with them regarding funeral arrangements. School & funeral should not compete for students’ time.

5. Memorials and plaques should be downplayed. Media contact needs to be carefully planned and follow recommended guidelines.


Postvention – 1st Day (Cont)

6. Have crisis team, counselors, and school psychologists identify any students who seem to be at particularly high risk for suicidal behavior (i.e., close friends, siblings, girlfriend/boyfriend, & past attempters).

7. School schedule should be reimplemented after school principal, staff, and crisis team feel appropriate time has been given for expression of feelings and communication. Tests should be rescheduled for another day & no repercussions for missing class.

8. Empty chair strategy following student’s schedule – crisis response person or person trained in handling crisis situations.

9. A designated room/office should be available for students still struggling with this event. This office should be available for these students for the rest of the week.


Postvention – 2nd & 3rd Days1. Crisis team remains in the school and counselors/school psychologist should still offer small group discussions if students come down to the designated room/office.

2. Announcements in the morning should include the available of resources for students who continue to struggle with the tragic news. If a funeral time has been reached by the family, included this as well. Ideally, the best time is in the late afternoon or evening.

3. Counselor & school psychologists should develop a checklist of those who are still struggling and check-in with those people each day.

4. Maintain contact with family – offer support and provide community resources for them.

5. Keep everyone updated on the situation: community, family, and school.


Postvention – 1 & 2 weeks after

1. Check-in with those who were on the checklist – ask how they are currently feeling. Let them know they can stop by to talk whenever they want.

2. Review the crisis plan and make adjustments based on what transpired during the past event.

3. Check-in with the family to see if there is anything else that the school/community can be of assistance.

4. Meet with administrators to identify upstream approaches for the upcoming year (or two) that will stem the flow of students who become at-risk for suicide.


II. Goals for Suicide Postvention Procedures

Postvention Procedures

Use a calling tree

Faculty & staff meeting before school

Counselor should follow S’s schedule and attend his/her classes

Counselor or School Psychologist make contact w/parents and offer assistance


II. Goals for Suicide Postvention Procedures

Postvention Procedures (cont)

Acknowledge the death honestly

Discussions should occur in small groups

Spokesperson designated to meet with media

Keep principal/superintendent informed and updated


III. Specific DO’s and DON’Ts for Suicide Postvention

DO’s

Do reach out to Parents and provide support for them

Funeral should not compete with school

Do provide a flexible school schedule



DO’s (cont 2)

Do answer students’ questions honestly

Do explain that suicide is often a result of mental health issues

Do stress that suicide is preventable and everyone can help



DO’s (cont 3)

Do provide resources for students who are feeling at risk for suicide

provide crisis hotline numbers

Teen line - 866 TEENLINK

National Hotline - 800 273-TALK

Do stress the positive strategies going on at the school



DO’s (cont 4)

Do make sure all students hear the news at the same time

Do identify others who could be at additional risk

Friends, siblings, and past students who have attempted suicide



DO’s (cont 5)

Do send a letter home to all parents regarding the situation. Include

What the school is doing/offering

Community resource numbers

Warning signs for suicidal behavior

Example of how parents can talk to their teens about suicide



DO’s (cont 6)

Do remember anniversary dates

Identify those that may be affected by the anniversary date

Close friends/relationship partners

Siblings, even if they attend a different school



DO’s (cont 7)

Do return the school back to its regular schedule as soon as possible

Students need the consistent and predictable structure school offers

Helps students regulate their emotions



DON’Ts

Do not hold an all school assembly

Do not announce news over the PA system

Do not plan any memorials beyond what is done for typical student deaths

Do not deny access of information



DON’Ts (cont 2)

Do not punish students for taking extra time to deal with the crisis

Do not judge S’s past behavior

Do not report the suicide as unexplainable or blame anyone



DON’Ts (cont 3)

Do not try to answer the ? “why” question because you do not know

Do not print pictures of the deceased

Do not print story on front page and avoid details of methods


IV. American Association of Suicidology

Guidelines for dealing with the Media

Avoid details of the method

Do not report the suicide as unexplainable

Avoid making the story front-page news

Do not print a photograph of the deceased


IV. American Association of Suicidology

Guidelines for dealing with the Media (cont)

Refrain from coverage that excites or sensationalizes

Do not imply approval of suicide

Avoid discussing the specific details of the situation

Include positive outcomes of the suicidal crisis

Include information about warning signs, sources of help, and what to do if someone is suicidal


National Resource and Information Numbers

American Association of Suicidology

www.suicidology.org

202 237-2280

National Suicide Prevention Lifeline

800 273-TALK


http://www.suicidology.org/

National Resource and Information Numbers

Miller, D.N. (2011). Child and Adolescent Suicidal Behavior: School-Based Prevention, Assessment, and Intervention. New York, NY: Guilford.

After a Suicide: A Toolkit for Schools: www.sprc.org/sites/sprc.org/files/library/AfteraSuicideToolkitforSchools.pdf


http://www.sprc.org/sites/sprc.org/files/library/

James J. Mazza, Ph.D.Miller Hall, Box 353600University of WashingtonSeattle, WA 98195-3600(206) [email protected]

Business Card



youth suicidal behavior and postvention · 2018. 11. 27. · bullying prevention **coping...

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