Suicide

1. Suicide A permanent solution to a temporary problem.

2. Suicide facts • Every four hours in America a child commits suicide (Children’s Defense Fund, 1999) • An estimated 10-25% of the students in any high school are at risk for suicide in any given school year (Hahn, cited in “Suicide in Children,” 1998)

3. Suicide Facts • In 1995, according to the CDC (1998a) 2,227 American children ages 10-19 year old committed suicide, and it is estimated that for every completed suicide there are 100-200 suicide attempts (“Suicide Facts,” 1998)

4. Suicide Facts • The United States has the highest suicide rate of 26 industrialized nations studied by the federal government, a rate that is double that of other countries, according to CDC medical epidemiologist Dr. Etnienne Krug (U.S. Tops in Child Murder,” 1997).

5. Suicide Facts • “Since 1950, the rates of unintentional injury, disease, and congenital anomalies have decreased among children in the United States, but … suicide rate have quadrupled” (U.S. Tops in Child Murders,” 1997).

6. Suicide Facts • Suicide is the third leading cause of death for youth between the ages of 15 and 24 and fourth for those 10-14. • The suicide rates of those between the ages of 10 and 14 has increased 196% in the last 15 years. • Overall, African Americans have had the highest increase in suicide completion rates in the 1990’s.

7. Suicide Facts • Gay and lesbian youth are 200-300% more likely to attempt suicide and they may comprise 30% of youth suicide annually. • More teenagers died from suicide than from cancer, birth defects, AIDS, pneumonia, influenza, and chronic lung disease combined.

8. The relationship between suicide and homicideA poem by a school shooter Sinking into my bed Homicidal thoughts filling my head Suicidal thoughts not gone, but fleeting Because it is other people’s death I am seeing Suicide or homicide Into sleep I am sinking Why me I am thinking Homicidal and suicidal thoughts intermixing My life’s not worth fixing Prior to school shootings ¾ of all attackers threatened to kill themselves, tried to kill themselves, or made suicidal gestures.

9. Nine Facts about Suicidal Individuals • The overwhelming majority of suicidal people (perhaps 95% of them) do not want to die. • The typical suicidal person wants to be rescued but has difficulty asking for assistance. • The suicidal person is confused and is searching for a strong, authoritarian person to direct his emotional traffic.

10. Facts continued • The suicidal person is in a highly suggestible state. They will likely respond to a voice of authority demanding that they behave in a prescribed manner. • Most suicidal people experience a suicidal episode only once in their lives. • People are acutely suicidal for only a brief period of time.

11. Facts continued • It is doubtful that anyone is constantly suicidal for an extended period of time. • The three important words that best describe a suicidal person are: • Hopeless • Helpless • Hapless • The typical suicidal person is experiencing multiple problems at the same time.

12. Erosion • Suicide is not a spontaneous activity. • The precipitating event is not the cause of the suicide. There is no single cause of a suicide – only causes (plural).

13. As a form of communication • If you understand that suicide is a demonstrative form of communication you will be less likely to treat the suicidal person in a punitive manner. • If you understand that suicidal behavior is an extreme form of communication, you will be more likely to recognize the early warning signs of suicidal risk.

14. Ambivalence • Ambivalence is the emotional state most closely associated with suicidal behavior. • Suicidal individuals often feel that they want to live and die at the same time. • Ambivalent feelings are most prominent shortly before the person begins to harm himself (herself). • The suicidal person is much more negative about life than positive about death.

15. Warning signs of suicide • Previous suicide attempts or threats • Prolonged depression • Means to complete the suicide have been secured • Preoccupation with suicide themes or death • Not tolerating praise or rewards

16. Warning signs continued • Destructive or repetitive behavior • Scratching, cutting, or marking on the body • Becoming suddenly cheerful after a period of depression (this may indicate that the decision to commit suicide has been made).

17. Warning signs continued • Loss of interest in pleasurable activities • Decline in quality of school work • Alcohol or drug use • Marked personality and/or behavior change • Persistent boredom, inability to concentrate

18. Warning signs continued • Risk-taking behavior • Physical symptoms associated with emotion (e.g. stomach ache & fatigue) • Putting affairs in order • Withdrawal from friends, family or activities • Verbal hints

19. Risk factors • Previous suicide attempts • Current ideation, intent, and plan (resolve) • Exposure to suicide and/or family history of suicide • Mental disorders – particularly mood disorders such as depression and bipolar disorder • Personality disorders (conduct and borderline)

20. Risk factors continued • Influence of significant people – family members, celebrities, peers who have died by suicide – both through direct personal contact or inappropriate media representations. • Local epidemics of suicide that have a contagious influence

21. Risk factors continued • Co-occurring mental and alcohol and substance abuse disorders • Hopelessness and helplessness • Impulsive and/or aggressive tendencies • Barriers to accessing mental health treatment • Relational, social, work, or financial loss • Physical illness

22. Risk factors continued • Easy access to lethal methods, especially guns • Unwillingness to seek help because of stigma attached to mental and substance abuse disorders and/or suicidal thoughts • Cultural and religious beliefs – for instance, the belief that suicide is a noble resolution of a personal dilemma

23. Risk factors continued • Isolation – a feeling of being cut off from other people • Ineffective coping mechanisms and inadequate problem solving skills • A confluence of multiple stressors (discipline, rejection/humiliation, end of romantic relationship, conflict with family or peers, unmet school goals

24. Protective Factors • Effective problem solving and interpersonal skills including conflict resolution and nonviolent handling of disputes. • Contact with a caring adult. • A sense of involvement/belonging to one’s school, based on opportunities to participate in school activities and contribute to the functioning of the school (effective, positive school climate).

25. Protective Factors continued • Effective and appropriate clinical care for mental, physical, and substance abuse disorders • Easy access to a variety of clinical interventions and support for those seeking help • Restricted access to highly lethal methods of suicide

26. Protective Factors continued • Family and community support • Support from ongoing medical and mental health care relationships • Cultural and religious beliefs that discourage suicide and support self-preservation instinct

27. Getting into trouble with authorities (e.g., school, police) Breakup from boy/girl friend Death of a loved one Disappointment and rejection such as a dispute with boy/girl friend, failure to get a job, or rejection from college Bullying or victimization Conflict with family or family dysfunction Disappointment with school results or school failure High demands at school during examination periods Unwanted pregnancy, abortion Infection with HIV or other sexually transmitted diseases Suicide Precipitants?

28. The anniversary of a death of a friend or a loved one Knowing someone who committed suicide Separation from friends, girl friends/boy friends Real or perceived loss Serious physical illness Serious injury that may change the individual’s life course. Suicide precipitants?

29. People who talk about suicide do not commit it You should not discuss suicide with youth because it gives them the idea to commit the act Children are not capable of implementing a suicide plan successfully. Suicidal youth really want to die. When the depressive mood of a child improves, the threat of a suicide crisis is over Children under the age of six do not commit suicide Only white males attempt suicide Common Suicide Myths

30. Once a youth contemplates suicide he or she should always be considered suicidal Suicide is inherited or destined through genetics There is nothing anyone can do to prevent a suicide There are usually no warning signs of a suicide Common Suicide Myths

31. The Do’s of Suicide Intervention • Take away accessibility to the means • Adapt a positive approach, emphasize desirable alternatives • Sound calm and understanding • Use constructive questions to define the problem and remove confusion • Rephrase the important thoughts and feelings

32. The Do’s of Suicide Intervention • Mention the family as a source of support if appropriate • Emphasize the temporary nature of a person’s problems (This too shall pass).

33. The Don’ts of Suicide Intervention • Don’t sound shocked • Don’t stress the shock, embarrassment or pain that this could cause the family • Don’t engage in debate • Don’t try to physically remove a weapon

34. Identify pre-existing risk factors: Individuals Events Alter curriculum Manage stress Students Faculty/Staff Parents Create and maintain discipline plan Teach anger management Conflict resolution and mediation training Commit to health and safety at all levels Prevention

35. Promote inquiry Construct and create a safe environment Identify those at risk Create partnerships with the community Become a community – school connectedness Reach out to those who are different by choice or accident Include parents Train staff to listen BE PREPARED The role of the school

36. www. ChildrensSafetyNetwork.org