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College Students and Suicide Prevention – Faculty and Staff

College Students and Suicide Prevention – Faculty and Staff

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College Students and Suicide Prevention – Faculty and Staff

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  1. College Students and Suicide Prevention – Faculty and Staff Ellen J. Anderson, Ph.D., SPCC Person To Person Resources andyphd@verizon.net May 27, 2009

  2. College Student Suicide • Suicide is the second leading cause of death for college students • The number one cause of suicide for college student suicides (and all suicides) is untreated depression College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  3. Despair At A Young Age • “Unlike most disabling physical diseases, mental illness begins very early in life. Half of all lifetime cases begin by age 14; three quarters have begun by age 24. Thus, mental disorders are really the chronic diseases of the young,” (National Institute of Mental Health) • Anxiety disorders often begin in late childhood • Mood disorders in late adolescence • Substance abuse in the early 20’s • Unlike heart disease or most cancers, young people with mental disorders suffer disability when they are in the prime of life, when they would normally be the most productive College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  4. Despair At A Young Age • Many young people who come to college have not yet been diagnosed with Depression, Schizophrenia, or Bi-Polar Disorder • We are seeing an increase in suicidal ideation and behavior on campus as more people with severe mental illness attend college • Improved treatment has allowed many young people to continue a normal life despite the development of severe mental illnesses College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  5. Despair At A Young Age • In general, non-college young adults complete suicide at about twice the rate as college students • Foreign students may have a higher risk for suicide • Suicide is not more frequent in any of the four years of college, but it does occur more often in students who take more than four years to earn their degrees College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  6. High Levels Of Stress • Going to college can be a difficult transition period in which students may experience high levels of stress, which can lead to Clinical Depression • Many college students also use higher levels of alcohol and drugs than at earlier times in their lives, increasing the risk of suicidal ideation • A hallmark of diagnosis for clinical depression is the presence of suicidal thinking • Yet our lack of knowledge about this illness means that we don’t seek help, and our friends and family don’t push us to get help College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  7. Unwilling To Seek Help • Stigma about treatment means that very few people with suicidal ideation actually seek treatment • Additionally, a survey indicates that one in five college students believe that their depression level is higher than it should be, yet only 20% say they would go to the campus counseling center • Those whose symptoms improve when they activate a suicide plan may be especially resistant to seeking help • Nearly half of suicidal students present for some medical treatment in the months before completing suicide although they may not acknowledge suicidal thoughts College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  8. Awareness • Faculty, coaches, advisors and residence hall staff should focus not only on disruptive students, but also on those who are quietly withdrawn or whose dormitory discussions or classroom essays disclose hopelessness and suicidal thinking • Training in awareness about depression and suicidal thinking is important for everyone on campus • Policies should be in place to discover students with suicidal ideation and help them to recover College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  9. How Common Is Suicide Among Teenagers And Young Adults? • Suicide is the 3rd largest killer of young people between the ages of 10 and 25, and the 2nd largest killer of young adults • Suicidal ideation is admitted by about 25% of adolescents at some time during high school • Suicide attempts are more frequent among the young than the old, although completions are less likely • About 4,000 young people die from suicide every year in the US • Teen suicide tripled between 1950 and 1990, but had dropped somewhat until 2003 • Around the world, adolescent suicide declined in industrialized nations with the increase in use of anti-depressant medication, despite fears that meds will increase suicidal behavior in teens College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  10. How Serious Is The Problem On Campus? • Nearly half of all students at some point find themselves feeling so depressed they have trouble functioning • 15 % meet the criteria for clinical depression, according to a 2004 survey by the American College Health Association • Among students seen at campus counseling centers, the number taking psychiatric medications rose to 24.5 percent in 2003-2004 • 17 % in 2000 • 9 % in 1994, according to the National Survey of Counseling Center Directors (Duenwald, 2004, NYTimes) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  11. What Is Mental Illness? Prior to our understanding of illness caused by bacteria, most people thought of any illness as a spiritual failure or demon possession Contamination meant spiritual contamination People were frightened to be near someone with odd behavior for fear of being contaminated-spiritually damaged College Suicide Prevention - Ellen Anderson, Ph.D., SPCC Gatekeeper Training- Dr. Ellen Anderson 11

  12. What Is Mental Illness? What do we say about someone who is odd? Looney, batty, nuts, crazy, wacko, lunatic, insane, fruitcake, psycho, not all there, bats in the belfry, gonzo, bonkers, wackadoo, crazy Why would anyone admit to having a mental illness? So much stigma makes it very difficult for people to seek help or even acknowledge a problem College Suicide Prevention - Ellen Anderson, Ph.D., SPCC Gatekeeper Training- Dr. Ellen Anderson 12

  13. What Is Mental Illness? We know that illnesses like epilepsy, Parkinson's and Alzheimer’s are physical illness in the brain Somehow, clinical depression, anxiety, Bi-Polar Disorder and Schizophrenia are not considered physical illnesses requiring treatment We confuse brain with mind Talking about suicide is taboo- which means no research, no grants, no place for discussion on campus College Suicide Prevention - Ellen Anderson, Ph.D., SPCC Gatekeeper Training- Dr. Ellen Anderson 13

  14. 87 people complete suicide every day 32,466 people in 2005 in the US Over 1,000,000 suicides worldwide (reported) This data refers to completed suicides that are documented by medical examiners – it is estimated that 2-3 times as many actually complete suicide (Surgeon General’s Report on Suicide, 1999) Is Suicide Really a Problem? College Suicide Prevention - Ellen Anderson, Ph.D., SPCC Gatekeeper Training- Dr. Ellen Anderson 14

  15. The Gender Issue Women perceived as being at higher risk than men Women do make attempts 4 x as often as men But - Men complete suicide 4 x as often as women Women’s risk rises until midlife, then decreases Men’s risk, always higher than women’s, continues to rise until end of life Are women more likely to seek help? Talk about feelings? Have a safety network of friends? Do men suffer from depression silently? College Suicide Prevention - Ellen Anderson, Ph.D., SPCC Gatekeeper Training- Dr. Ellen Anderson 15

  16. What Factors Put Someone At Risk For Suicide? Biological, physical, social, psychological or spiritual factors may increase risk-for example: A family history of suicide increases risk by 6 times Access to firearms – people who use firearms in their suicide attempt are more likely to die Social Isolation: people may be rejected or bullied because they are “weird”, because of sexual orientation, or because they are getting older and have lost their social network (Goleman, 1997) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC 16 Gatekeeper Training- Dr. Ellen Anderson

  17. A significant loss by death, separation, divorce, moving, or breaking up with a boyfriend or girlfriend can be a trigger The 2nd biggest risk factor - having an alcohol or drug problem Many with alcohol and drug problems are clinically depressed, and are self-medicating for their pain (Surgeon General’s call to Action, 1999) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC Gatekeeper Training- Dr. Ellen Anderson 17

  18. The biggest risk factor for suicide completion? Having a Depressive Illness Clinically depressed people often feel helpless to solve problems, leads to hopelessness – a strong predictor of suicide risk At some point in this chronic illness, suicide seems like the only way out of the pain and suffering Many Mental health diagnoses have a component of depression: anxiety, PTSD, Bi-Polar, etc 90% of suicide completers have a depressive illness (Lester, 1998, Surgeon General, 1999) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC Gatekeeper Training- Dr. Ellen Anderson 18

  19. Depression Is An Illness • Our cultural view of suicide is wrong - invalidated by current understanding of brain chemistry and it’s interaction with stress, trauma and genetics on mood and behavior • Suicidal thinking is a severe symptom of the way depression is altering the brain – causing changes in thinking, mood and body regulation • Suicide has been viewed for centuries as: • a moral failing, a spiritual weakness, a mortal sin • an inability to cope with life • “the coward’s way out” • A character flaw • This view must be replaced by more current understanding of brain disorders as treatable, physical illnesses College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  20. The research evidence is overwhelming - depression is far more than a sad mood. It includes: • Body Regulation Problems • Weight gain/loss • Sleep problems • Sense of tiredness, exhaustion • Mood Regulation Problems • Sad or angry mood • Loss of interest in pleasurable things, lack of motivation • Irritability • Thinking and Memory Problems • Confusion, poor concentration, poor memory, trouble making decisions • Negative thinking • Withdrawal from friends and family • Often, suicidal thoughts (DSMIVR, 2002) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  21. 20 years of brain research teaches that these symptoms are the behavioral result of Changes in the physical structure of the brain Damage to brain cells in the hippocampus, amygdala and limbic system Depressed people suffer from a physical illness – what we might consider “faulty wiring” (Braun, 2000; Surgeon General’s Call To Action, 1999,Stoff & Mann, 1997, The Neurobiology of Suicide) Gatekeeper Training- Dr. Ellen Anderson 21 College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  22. Faulty Wiring? • Literally, damage to certain nerve cells in our brains - the result of too many stress hormones • Cortisol • Adrenaline • Testosterone – hormones activated by our Autonomic Nervous System to protect us in times of danger • Chronic stress causes changes in the ANS, so that “fight or flight” is set off with little stimulus • Constant stress hormone production without a way to relax causes physical changes in the brain and body (Goleman, 1997, Braun, 1999) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  23. Faulty Wiring? • Constant ANS activation causes changes in muscle tension, imbalances in blood flow patterns - leads to asthma, IBS and depression, increased risk for death from heart disease • People with genetic predispositions, placed in a highly stressful environment will experience damage to brain cells from stress hormones • This leads to the cluster of thinking and emotional changes we call depression • Stress alone is not the problem, but our interpretation of the event (Goleman, 1997; Braun, 1999) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  24. One of Many Neurons • Neurons are the cells that make up the brain and their united, networked action is what causes us to think, feel, and act • Neurons must connect to one another (through dendrites and axons) • Stress hormones damage dendrites and axons, causing them to “shrink” away from other connectors • As fewer and fewer connections are made, more and more symptoms of depression appear Gatekeeper Training- Dr. Ellen Anderson 24 College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  25. How Can We Stop Brain Damage? • As damage occurs, thinking changes in the predictable ways identified in our list of 10 criteria • Four things can reduce this “brain damage” • Stress reducing mental exercises - meditation • Exercise • Antidepressant medication • Cognitive/Behavioral Psychotherapy College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  26. Many cultures have developed stress reduction rituals/mental exercises – Yoga, Tai Chi, Qi Jong, meditation, prayer – these millennia old methods work well to reduce stress hormone production • Exercise can help “burn off” high stress hormone levels and even reduce production • Antidepressants can counter the effects of stress hormones • We know now that antidepressants stimulate genes within the neurons (turn on growth genes) which encourage the growth of new dendrites • New dendrites reconnect neurons and symptoms are reduced • It can take longer than six weeks for the brain to repair itself enough that people feel better (Braun, 1999) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  27. How Does Therapy Help? • Medications may relieve physical suffering and improve brain function, but do not change how we interpret stress • Cognitive or interpersonal psychotherapy helps people change the (negative) patterns of thinking that lead to depressed and suicidal thoughts • Changing our inaccurate beliefs and thought patterns alters our response to stress – we are not as reactive or as affected by stress at the physical level • Research shows that cognitive therapy is as effective as medication in reducing depression and suicidal thinking (Lester, 2004) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  28. How Does Therapy Help? • “The Talking Cure” as Freud originally called it turns out to have a scientific basis for success • Daniel Goleman, Daniel Siegal, Antonio D’Amasio and others are explaining how social interaction with others literally alters our neuronal paths, allowing different ways of thinking to change the chemical, electrical and thought pattern flow in our brains • We know that people raised in highly abusive homes have visibly different brains than people from normal homes, as seen on MRI’s and CAT scans • We also know that healing relationships, changed perspectives (reframing) and altered self-beliefs change how people react to stress College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  29. Possible Sources Of Depression Genetic: a predisposition to this problem may be present, and depressive diseases run in families Predisposing factors: Childhood traumas, car accidents, brain injuries, abuse and domestic violence, poor parenting, growing up in an alcoholic home, chemotherapy Immediate triggers: violent attack, illness, sudden loss or grief, loss of a relationship, any severe shock to the system (Anderson, 1999, Berman & Jobes, 1994, Lester, 1998) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC Gatekeeper Training- Dr. Ellen Anderson 29

  30. What Happens If We Don’tTreat Depression? Significant risk of increased alcohol and drug use Significant relationship problems Lost work days, lost productivity (up to $40 billion a year) High risk for suicidal thoughts, attempts, and possibly death (Surgeon General’s Call To Action, 1999) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC Gatekeeper Training- Dr. Ellen Anderson 30

  31. What Are "Best Practices" In Staff Training And Educational Programming • The United States Air Force model • Develop a campus-wide commitment to suicide prevention • Reduce stigma against seeking professional help • Depression screening programs and online resources – Jed Foundation, American Foundation For Suicide Prevention College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  32. What Are Administrative Responsibilities? • We should not be looking at student suicide primarily from a risk-management perspective • College administrator responses to students seem to become defined legally and not through primary responsibility as educators • “As educators, we have to take some risks. That means working harder to keep students at risk of suicide enrolled, working with them, giving them the help they need, and not finding faster and more creative ways to remove them. “ (Gary Pavela, 2006, The Chrone) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  33. A Protective Environment • Mandatory-removal policies carry legal risks of their own - ADA • Office for Civil Rights within the U.S. Department of Education has been called upon to issue letter rulings pertaining to these policies – students with documented mental health diagnoses may win a lawsuit • The risk of liability for suicides is low – most cases focus on high risk immediate suicidality • College administrators, may err on the side of under-reaction, in terms of notifying parents, in terms of hospitalization • Decisions in some recent cases do not define the law nationally and do not mean your proper response as an administrator is to find a quick way to get rid of the student • Cases point to reacting promptly and appropriately to a student who is manifesting imminent risk of suicide (Pavela, 2006) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  34. Parental Notification • Should colleges notify parents of students at risk of suicide? • Previously, a strong bias not to notify parents about student problems • In recent years a shift toward more parental notification • FERPA [Family Educational Rights and Privacy Act] amended; able to notify parents in certain alcohol incidents • Who should notify parents and under what conditions? • Mental-health professionals will have a legal and ethical obligation to breach confidentiality in an emergency, when a person is at imminent risk of harming themselves • Parents would be notified by the hospital • When students enroll, it should be part of their file: Who do you want notified in case of emergency? College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  35. Parental Notification • Administrators have more latitude than mental-health professionals to notify parents • Err on the side of treating suicidal statements as a genuine suicide threat or gesture, • Arrange for immediate evaluation of that student, • Ask the student about needing to involve the parents immediately, • Listen to arguments about why that wouldn't work, and talk to a mental-health professional. • Once there is a suicide threat or gesture - notify parents, even when it isn't a full-blown emergency College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  36. Should Colleges Withdraw Students Who Threaten Or Attempt Suicide? • Rate of young-adult suicide for people going to college is about one-half of the rate for young adults who are not going to college • Campus environments, human connection, and limited access to firearms are protective • College campuses do a good job of limiting firearms, the most dangerous choice of a suicide weapon • Sending kids home means taking them out of a protective environment • Use the administrative process as a lever to get the student help • Policies can use the threat of removal as "leverage" • We are a community that can't tolerate violence, including violence to self, and we have a mechanism to help you, if not, we can remove you College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  37. Jed Foundation Prevention Model College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  38. Empowering Students To Help Prevent Suicides Among Peers • Often peers know about potentially suicidal and depressed behavior and comments • Increase discussion with students about the responsibility of friendship • A higher loyalty is to save a person's life, not keep a person’s secret • Friends don't let depressed students handle their problem alone, and they get help for that student, even if they have to break confidentiality • Teach when to get help and where to get it – this goes beyond the ability of friendship to manage College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  39. What Are Faculty Responsibilities? • Faculty members and others are seldom mental health professionals, but may be mentors who can become aware of students experiencing hopelessness • As educators, we need to help students become more aware of symptoms that might mean they need treatment • This means educating ourselves to know what the symptoms of depression and suicidal thinking are, and becoming able to move past the centuries old taboo against talking about these problems as something other than an illness College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  40. Faculty Must React Appropriately • Training is needed so that faculty will not under-react to suicidal references • Training to understand what depression is and how it can lead to suicide • Realizing that relationship and support is not enough – we don’t simply offer kindness when someone is having a heart attack College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  41. Mentoring and Connection • One of the triggering factors to depression is isolation, the feeling of not being a part of a community • College students still need adult support and someone to talk with • Faculty and students alike need training in these issues, but stigma makes it difficult for people to talk openly • Try a stress-management seminar • Talk about relationship issues, as many suicidal thoughts come up as a response to relationship loss • Don’t be afraid to bring up suicide in any appropriate discussion setting College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  42. What On Earth Can I Do? • We are reluctant to ask questions of depressed students because we feel it is “none of my business”, or fear the responsibility • Depression is an illness, like heart disease, and suicidal thoughts are a crisis, like a heart attack • Anyone can learn to ask the right questions to help a depressed and suicidal person College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  43. What Stops Us? • Most of us still believe suicide and depression are “none of our business” • Most are fearful of getting a yes answer • What if we knew how to respond to “yes”? • What if we could recognize depression symptoms like we recognize symptoms of a heart attack? • What if we were no longer afraid to ask for help for ourselves, our parents, our children? • What if we recognized our feelings of despair and hopelessness, as symptoms of a brain disorder? College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  44. Learning “QPR” – Or, How To Ask The “S” Question • It is essential, if we are to reduce the number of suicide deaths in our country, that community members/gatekeepers learn “QPR” • First identified by dr. Paul Quinnett as an analogue to CPR, “QPR” consists of • Question – asking the “S” question • Persuade– getting the person to talk, and to seek help • Refer – getting the person to professional help (Quinnett, 2000) College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  45. Ask Questions! • Ask questions about suicide like, "Do you ever… •  have thoughts of hurting yourself? •  feel so badly that you have thoughts of dying? •  wish you could runaway or disappear? •  wish you could go to sleep and not wake up? •  have scary dreams about dying? • Remember, you cannot make someone suicidal by talking about it. If they are already thinking of it they will probably be relieved that the secret is out. • If you get a yes answer, don’t panic. Ask a few more questions. College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  46. Reduce Stigma • Knowing what to ask and where to get help is not enough • Reducing the fear and shame we carry about having such “shameful” problems can only be done through a public health approach • Shame keeps people from seeking help or talking about their pain • Teach people that depression is truly a disorder that can be treated – a deadly killer that we can no longer ignore or fear discussing College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  47. Do . . . • Talk openly- reassure them that they can be helped - Try to instill hope • Encourage expression of feelings – say “Tell me more” • Listen without passing judgment • Make empathic statements • Use warning signs to get help early for the individual, • Stay calm, relaxed, rational College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  48. Don’t… • Make moral judgments– don’t argue or lecture • Encourage guilt • Promise total confidentiality/offer reassurances that may not be true • Offer empty reassurances – “you’re luckier than most people” won’t help • Minimize the problem/offer simplistic solutions(e.g. “all you need is a good night’s sleep”) • Dare the suicidal person (e.g.“You won’t really do it.”) • Use reverse psychology (e.g. “Go ahead and kill yourself.”) • Leave the student alone College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  49. Never Go It Alone! • Get help!!! • A friend: go to a teacher, your parent, their parents, a counselor, a pastor • If it is you – ask for help right now! Talk with: • Family and friends • School Personnel • Crisis Hotline • Community Agencies • Family doctor • Clergy • If it is your parent/grandparent – get adult help – Clergy, Guidance counselor, crisis line, family doctor College Suicide Prevention - Ellen Anderson, Ph.D., SPCC

  50. College Counselors Staff nurses Local Crisis Hotlines Local Clergy 911 Hospital Emergency Room Local Mental Health Agencies Local Mental Health Board National Crisis Hotlines Physicians Local Police/Sheriff Local Professional Resources College Suicide Prevention - Ellen Anderson, Ph.D., SPCC