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Slide 1
SUICIDE PREVENTION, INTERVENTION & POSTVENTION IN SCHOOLS
An Overview for Board Leaders
Slide 2
SUICIDE IS A DIFFICULT TOPIC Most of us have been touched,
professionally and/or personally, by suicide Important to support
one another as we approach this topic today.and in days following
No scheduled breaks, come and go as is right for you If you would
like to talk to someone, we are available to help.
Slide 3
CONTEXT FOR THE PRESENTATION This presentation targets the
Board Mental Health Leadership Team It is designed to: Build common
understanding about suicide amongst board mental health leaders
Highlight helpful prevention, intervention and postvention
strategies Provide recommendation actions for consideration at the
system level The accompanying presentation for School Mental Health
Leaders mirrors this content, but adds specific detail relevant for
schools
Slide 4
SESSION OUTLINE Brief Overview of Suicide in Children and Youth
Suicide Prevention, Intervention & Postvention Strategies
Issues for Board Leaders Recommended Actions for the MH Leadership
Team Roles and Protocols (mh leadership team, senior
administration, school administration, critical incident response
team) Strategies (early identification and treatment of mental
health problems, youth engagement, community culture building)
Capacity-Building (information dissemination, gatekeeper training,
media education)
Slide 5
CHILD AND YOUTH SUICIDE Brief Overview
Slide 6
SUICIDAL BEHAVIOUR Non-Suicidal Self-Injury a deliberate
attempt to cause injury to ones body without the conscious intent
to die Suicidal Ideation Suicidal thoughts that include both
contemplating death by suicide and planning actions that could
result in death Suicide Attempt self-harming behaviour that
includes an intention to die Death by Suicide self-harming
behaviour that results in death
Slide 7
FACTS AND FIGURES 2 nd leading cause of death after accidents,
accounting for 17.3- 20.4% of adolescent mortality (but important
to put this in context, death is relatively uncommon in this age
group) 1.4% of all suicides occur in children under 14 years of age
Death by suicide is more prevalent in males than females aged 15-19
Recent Canadian epidemiological study shows overall stable rates of
suicide over the past 30 years, but trends are changing: decreasing
rates for males and increasing rates for females (Skinner &
McFaull, 2012)
Slide 8
THE COMPLEXITY OF RISK Vulnerabilities (Distal) Triggers
(Proximal) Risk Protective Factors
Slide 9
VULNERABILITIES - SELF Mental illness (e.g., mood, anxiety,
conduct disorders) Past suicidal behavior Substance use Unstable
mood, high impulsivity Rigid thinking or coping patterns Poor
physical health / chronic illness NOTE: These risk factors are
correlational and not causal; typically it is a compounding of risk
factors that is associated with suicidal behavior.
Slide 10
VULNERABILITIES - HOME Family history of suicides / attempts
Parental mental illness Alcohol / substance abuse in the home
History of violence and/or abuse Divorce, separation, other losses,
death Tension and aggression between parents Parental lack of time;
rejection; neglect NOTE: These risk factors are correlational and
not causal; typically it is a compounding of risk factors that is
associated with suicidal behavior.
Slide 11
VULNERABILITIES SCHOOL/COMMUNITY Learning problems
Disengagement from school Lack of connectedness Marginalization
Discontinuity in identity (cultural, language, gender, sexual) Some
communities are at heightened vulnerability (e.g., aboriginal,
LGBTQ, homeless) Negative social relationships, including
bullying
Slide 12
Pre-existing vulnerability Increases risk for bullying
Victimization New or Exacerbated: Anxiety Depressed mood Diminished
self-worth Feelings of entrapment Loneliness Withdrawal
Sleep/eating problems Hopelessness Which are risk factors for:
Suicidal ideation Suicide attempt Death by suicide Adapted Lenny
Berman 2010 Bullying and Suicide 8doc.webinar American Association
of Suicidology BULLYING AND SUICIDAL BEHAVIOR
Slide 13
TRIGGERS Break up with boy/girl friend Conflicts and increased
arguments with parents and/or siblings Loss of close friend School
related difficulties-conflicts with teachers, classmates
Difficulties with the law Change in parents financial status
Serious illness or injury in family member Real or perceived loss
of status
Slide 14
CONTAGION Occurs when suicidal behavior influences an increase
in the suicidal behavior of others Multiple suicidal
behaviors/suicide deaths that occur within a geographical area or
fall within an accelerated time frame may represent a potential
cluster Although clusters are rare, they are most common amongst
adolescents
Slide 15
CIRCLES OF VULNERABILITY Geographical Proximity Social
Proximity Psychological Proximity Population at Risk Lahad &
Cohen, 2006
Slide 16
THE ROLE OF CYBER/SOCIAL MEDIA Increasingly there are sites,
chat rooms and blogs that promote suicidal ideation Methods of
suicide are discussed on-line and some researchers have suggested
that increases in particular methods in recent years may be related
to this dialogue The rapid spread of rumours and details of deaths
by suicide is difficult to manage Paradoxically, social media may
hold potential benefits for suicide prevention (Skinner &
McFaull, 2012)
Slide 17
THE ROLE OF MEDIA Media can be helpful or harmful it is never
benign and they cannot view themselves as impartial observers
Contagion (mimicking of suicidal behavior) is a real phenomenon and
youth are particularly vulnerable Media needs to be held
accountable for adhering to safe reporting guidelines following a
death by suicide Media can be helpful in bringing awareness to
issues of child and youth mental health more broadly
Slide 18
RESPONDING TO MASS MEDIA / SOCIAL MEDIA COVERAGE Recent weeks
have brought us A very tragic example of the complexity of suicidal
behavior An illustration of the influence and dangers of social
media Irresponsible media coverage and oversimplification of the
issues in much public discourse Well-intentioned, but potentially
harmful, actions Contagion A magnification of the need for district
and school leadership to ensure student safety
Slide 19
PROTECTIVE FACTORS Problem solving, life & communication
skills Sociability Resilient Personality A sense of belonging
(school, community) Secure attachment to positive parent/family
Access to other caring & supportive adults Pro-social peers
Appropriate discipline, limit setting & structure Opportunities
to develop self-esteem Good Mental Health
Slide 20
Youth suicide is complex and is often the result of many
converging factors. The explanations and the solutions are equally
complex.
Slide 21
WHAT CAN WE DO? Reduce vulnerabilities - at school Ensure
school is safe and accepting, especially for vulnerable students
(enhance sense of belonging, increase connectedness and engagement,
show respect for differences) Build on protective factors Provide
skill-building, opportunities to build esteem, etc. Look out for
triggers Identify students at risk, listen Minimize the risk for
contagion Have a plan for help
Slide 22
SUICIDE PREVENTION, INTERVENTION, & POSTVENTION Strategies
for
Slide 23
FIRST, DO NO HARM In considering various prevention,
intervention, and postvention strategies, the Mental Health
Leadership Team needs to understand that this area of work is not
benign Some actions are more effective than others, some are risky,
and many have not been evaluated rigorously This may mean taking a
fresh look at existing practices to ensure alignment with the
evidence base in this area Close communication with your senior
administration team will be important if practice changes are
required
Slide 24
THROUGH THIS SECTION, CONSIDER What is your board doing
consistently across the system in suicide prevention, intervention
and postvention? Are these initiatives aligned with the
evidence-base? Review the companion School Mental Health Leaders
presentation and determine if this is the right time to share this
information with school administrators in your board
Slide 25
SCHOOL RESPONSE TO SUICIDE Four components: Administrative
Foundation, Prevention, Intervention & Postvention
Slide 26
WHAT IS ADMINISTRATIVE FOUNDATION? The administrative
foundation is the support and commitment of the school board, as
articulated through the principal, to policies and procedures that
address the range of needs presented by students who might be at
risk for suicide.
Slide 27
WHAT IS SUICIDE PREVENTION? Efforts to reduce the risk of
suicidal thoughts and behavior amongst students in a systematic
way
Slide 28
WHAT IS INTERVENTION? Practices involved in recognizing and
responding to students with suicidal ideation or behavior Practices
involved in supporting vulnerable students transitioning to and
from mental health care
Slide 29
WHAT IS POSTVENTION? Support for school communities in
responding to suspected, attempted, or death by suicide
Slide 30
HELPFUL PREVENTION STRATEGIES Safe and accepting school culture
Social emotional learning (coping skills, conflict resolution)
Early identification and treatment of mental health problems
Gatekeeper training Information dissemination (staff, parents,
students)
Slide 31
PREVENTION STRATEGIES TO AVOID There are risks inherent in the
following strategies: Suicide awareness curriculum with students,
particularly if done in a single or stand alone lesson(s)
(curriculum is best delivered in the context of instruction related
to mental health more generally, over a period of several lessons,
with a focus on protective factorsafter adults have received
gatekeeper training) Assigning suicide as a central or sole focus
of study Large assemblies with guest speakers who talk about
suicide Events that have the potential to glorify/glamorize suicide
Peer counseling related to suicide
Slide 32
Prevention StrategyEvidence Early identification and treatment
of mental health problemsSolid School/community culture
buildingSolid Adaptive coping skill developmentSolid Information
dissemination / gatekeeper trainingPromising Screening and
referralMixed Youth engagement / peer helper programsMixed Suicide
awareness curricula for studentsMixed Means restrictionMixed Crisis
hotlinesMixed Media education programs Insufficient Evidence
Effective postvention Insufficient Evidence
Slide 33
HELPFUL INTERVENTION STRATEGIES Identification and Referral
Ensure staff aware of warning signals Ensure clear protocol at
school level Provide immediate and calm support to the student
Ensure safety and supervision Facilitate assessment and care
Contact parent/guardian Document actions
Slide 34
HELPFUL INTERVENTION STRATEGIES Supporting Vulnerable Students
Ensure staff understand role and limits of competence Support staff
with caring adult role Identify vulnerable students Work with
clinical staff, when involved Create a school safety plan for each
student, as needed Implement and monitor plans, as needed
Slide 35
INTERVENTION STRATEGIES TO AVOID Peer intervention models with
inadequate adult supervision and monitoring Recruitment of
gatekeepers who are uncomfortable / unready for the role Counseling
of high risk students by unqualified professionals
Slide 36
HELPFUL POSTVENTION STRATEGIES Understand the phases of
postvention Have a plan for who does what at each phase of
postvention First 24 hours Next 48-72 hours During the first month
Planning for the future Practice deliberate self- and
team-care
Slide 37
WORKING THROUGH PHASES The accompanying presentation for the
School Mental Health Team articulates considerations for the
postvention period, through these phases This difficult work is
usually led by the school admin team, with support from the
Superintendent, Crisis Response Team, MH leadership team, and
corporate communications, as needed Main message have a plan for
who does what at each phase of postvention
Slide 38
Information for All Schools in board, with support for
vulnerable schools Information for Parents/Guardians and the wider
school community Information for All Students, with support as
needed Information for All Staff, with Support for Vulnerable
Members Support for Vulnerable Students Support for Students in
Crisis and their Families Media Social Media
Slide 39
Documentation of Ontario community mobilization response
following a suicide cluster
Slide 40
A COMPREHENSIVE SUICIDE PREVENTION STRATEGY INCLUDES:
Proactive, universal strategies that promote a sense of belonging
at school (reaching out to vulnerable students) Wide-spread
instruction in adaptive coping skills, like problem solving and
conflict resolution Knowledge and skills for early identification
of mental health problems (with clear connections to service)
Gatekeeper training, with protocols for students at risk Effective
postvention, with protocols Other strategies? Evaluate!!
Slide 41
ISSUES FOR BOARD LEADERS Child and Youth Suicide
Slide 42
IT TAKES A VILLAGE Many players needed, to assume different
roles Suicide Strategy Planning and Communication E.g., Board
Mental Health Leadership Team, Senior Administration Team,
Corporate Communications / Public Relations, Community Partners
Suicide Prevention and Intervention E.g., Board Mental Health
Leadership Team, School Mental Health Professionals, School
Administration, School Staff, Community Partners Postvention E.g.,
Initial team may include: Principal/Vice-Principal(s), Critical
Incident Response Team, Superintendent, Board Mental Health
Leadership Team, Corporate Communications, Community Partners
Slide 43
PERTINENT ISSUES FOR BOARD LEADERS Determining a coordinated
board-wide approach Establishing systematic and proactive suicide
prevention initiatives within the context of wider mental health
promotion and prevention efforts Ensuring clear protocols and roles
for intervention with students exhibiting suicidal behavior
Developing or updating postvention protocols in light of new
realities Communicating the suicide strategy and related supports
and expectations
Slide 44
SUICIDAL BEHAVIOR IS A REALITY IN YOUR SCHOOLS BE PROACTIVE, BE
PREPARED
Slide 45
COMPONENTS OF AN EFFECTIVE SUICIDE STRATEGY Protocols for
students at risk Protocols following a death by suicide Broad focus
on mental health promotion, skill-building and caring school
cultures Staff education and training Media education Parent
education An effective strategy builds common understanding across
the board & community, and signals a systematic, proactive
approach
Slide 46
RECOMMENDED ACTIONS Board Leaders
Slide 47
CONSIDER. Roles and Existing/Needed Protocols Existing/Needed
Strategies (e.g., early identification and treatment of mental
health problems, youth engagement, community culture building)
Existing/Needed Capacity-Building (e.g., information dissemination,
gatekeeper training, media education)
Slide 48
GETTING ORGANIZED Identify Existing/Needed Teams (Board,
School, Critical Incident Response) Clarify Roles, as needed
Develop/update protocols for intervention & postvention
Develop/update tools/templates for intervention & postvention
Select and implement prevention strategies Stage capacity-building
efforts Communicate the suicide strategy to staff Monitor, evaluate
and refine the strategy Many boards have teams and tools in place.
For these boards, it is a matter of confirming that these resources
are aligned with the wider board strategy, ensure capacity, and
meet your needs within the current context.
Slide 49
IDENTIFY TEAMS* Board Suicide Strategy Team protocol
development, strategy selection, etc. Suicide Response Team support
school team, work with media, etc. School Suicide Strategy Team
protocol development, strategy selection Suicide Response Team
support students, staff, community, etc. Crisis Response Team
Support staff and students in need of immediate support
individually or in small groups * These may be existing leadership
teams at the board and school level, or subgroups within these
Slide 50
CLARIFY ROLES Leadership and Planning Teams Who will be
involved in protocol development, strategy selection, training,
communication, etc.? Response Teams Who will support the school and
the school team during the crisis? Following the crisis? Who does
what? For example, Who will contact the family, communicate with
staff, students, etc. Who will support the school response team?
Who will work with media? Who will work with community? Who will
link with mental health partners?
Slide 51
DEVELOP/UPDATE PROTOCOLS Consult with school leaders in
developing/updating protocols, particularly those who have worked
through postvention Work with local agencies to plan for community
mobilization during postvention Work with media to educate and
reinforce safe reporting guidelines Develop/update your
Intervention Protocol Develop/update your Postvention Protocol
Slide 52
DEVELOP/UPDATE TOOLS Create/select/adapt/update pertinent tools
and templates Make tools available to School Mental Health Teams
Intervention Fact sheets / warning signals At a glance protocol or
flowchart More detailed protocol with rationale Postvention Letters
for school community Scripts for students Key messages for media
Support documents for staff Documentation outline Critical incident
review form
Slide 53
SELECT AND IMPLEMENT PREVENTION STRATEGIES If you have a mental
health strategy that includes universal promotion and
skill-building, you are already doing some of this work Work with
caring and accepting schools professionals to enhance sense of
belonging in schools Prepare information for dissemination with key
groups Work towards mobilization of community
Slide 54
CAPACITY - BUILDING When possible, sequence capacity-building:
Senior Leaders School Leaders School Staff Gatekeeper Training
Parents Media Students Different audiences will have different
knowledge needs
Slide 55
COMMUNICATE WITH STAFF Communicate the protocol and related
tools and templates Board MH Team School Leaders School
LeadersSchool Staff Some messages may need to go directly from the
Board MH Team to all Staff and to media
Slide 56
MONITOR, EVALUATE, REFINE Documentation and debriefing of
actions and enablers/challenges is important; for prevention,
intervention, and especially postvention Postvention is
emotionally-charged, and the more that our actions can be
routinized the better While every situation is unique, each offers
learning opportunities that can be used in future
Slide 57
SOURCES, WITH THANKS MH Leader Suicide Subgroup Ian Manion,
Ontario Centre of Excellence for Child and Youth Mental Health Ian
Brown, School Mental Health ASSIST Stephan Roggenbaum &
Katherine Lazear, University of South Florida Key Resources: SAMHSA
Toolkit, Suicide Postvention Guidelines South Australia, Principal
Leadership 2009, NASP Postvention Strategies for School Personnel,
Kutcher 2008
Slide 58
CONTACT SCHOOL MENTAL HEALTH ASSIST Kathy Short, Ph.D.,
C.Psych. Director, School Mental Health ASSIST
[email protected] 905-527-5092, x2634 School Mental Health
ASSIST quipe dappui en sant mentale pour les coles