Schools

Suicide in a school community is very sad and often unexpected. However, with the highest rate of suicide in North Dakota being between the ages of 10 to 24, it is important to be prepared to identify warning signs and risk factors of suicide as well as have a plan in place on how to deal with a suicide. Utilizing your school's crisis team after a suicide may be helpful. Notifying students and teachers of the death, having parent meetings, and designating a media spokesperson are important parts of a crisis plan.

Note that parent meetings can provide a helpful forum for disseminating information and answering questions. However, large, open-microphone meetings are not advised, since they can result in an unwieldy, unproductive session focused on scapegoating and blaming.

Most adolescents have mastered basic skills that allow them to handle strong emotions encountered day-to-day, but these skills may be challenged in the face fo a school suicide. Adolescence often marks a time of increased risk for difficulties with emotional regulation. Emotional regulation refers to a person's ability to appropriately experience and express intense emotions such as grief and fear. Young people may not have learned how to recognize complex feelings or physical indicators of distress, such as stomach upset, restlessness or insomnia.  It is important to remember that most adolescents will experience very difficult times in their lives and not become suicidal.

What to say

• Give accurate information about suicide:
  • "Since 90 percent of people suffer from a mental disorder it is likely this student suffered from a mental disorder at the time of, his or her death."
  • "There are treatments to help people who are having suicidal thoughts."
  • "Mental disorders are not something to be ashamed of, and there are very good treatments to help the symptoms go a way."
• Address blaming and scapegoating:
  • "The reasons someone dies by suicide are not simple and are related to mental disorders. Blaming others or the person that died does not acknowledge the reality that the person was battling a mental disorder."
• Do not focus on the method or details of the suicide:
  • "It is tragic that this student died by suicide. Let's talk about how the death has affected you and ways to handle it."
  • How can we figure out the best ways to deal with our loss and grief?"
• Address anger:
  • "It's okay to feel angry. These feelings are normal and it doesn't mean that you didn't care about that person. You can be angry at someone's behavior and still care deeply about that person."
• Address feelings of responsibility:
  • "This death is not your fault."
  • "We can't always predict someone else's behavior."
  • "We can't control someone else's behavior."
• Encourage help-seeking:
  • "We are always here to help you through any problem, no matter what. Who are the people you would go to if you or a friend were feeling worried or depressed or had thoughts of suicide?"
  • "This is an important time for all in our school community to support and look out for one another. If you are concerned about a friend, you need to talk to a trusted adult."

Memorialization

When dealing with student deaths, it is important to treat all causes of deaths the same. When there are different approaches for the different causes of death it can reinforce the stigma that surrounds suicide. In the case of suicide, schools must consider how to appropriately memorialize the student who has died without risking suicide contagion among those surviving students who may themselves be at risk. Suicide contagion is the process by which one suicide may contribute to another. Contagion is relatively rare; however, adolescents appear to be at a greater risk than other age groups.

Social Media

Social media such as texting, Facebook and Twitter are rapidly becoming the primary means of communication for all ages, especially youth. It can be helpful to create a small group to monitor social networking sites and other social media. It is important to watch for inappropriate and hurtful comments, rumors and impromptu gatherings as well as comments of others expressing thoughts of suicide.

Suicide and Mental Health in Adolescents

Suicide is not simply the result of stress or difficult life circumstances. The key risk factor is an undiagnosed, untreated or ineffectively treated mental disorder. Suicide is always complicated. It is not the result of a difficult current life stressor. Suicide risk can be affected by personality factors such as impulsivity, aggression and hopelessness. It can be helpful to emphasize that the person who died by suicide was most likely struggling with a mental disorder. 

Common mental health conditions that can impact suicidal thoughts include:

• Major depressive disorder: Includes symptoms of sadness, depressed mood, angry or irritable moods and lack of interest or pleasure in activities the teen used to enjoy, lasting for a period of at least two weeks.
• Bipolar disorder: Includes alternating episodes of depression and mania with symptoms of mania lasting at least one week.
• Generalized anxiety disorder: Includes excessive, uncontrolled worry, occurring most days for a period of six months.
• Substance use disorders: Includes a problematic pattern of drug or alcohol use over 12 months or more, leading to significant impairment or distress.
• Conduct disorder: Includes repetitive, persistent pattern in adolescents of violating the rights of others, rules or social norms, occurring over 12 months.
• Anorexia nervosa and bulimia nervosa: Both are eating disorders that are strongly linked to other mental disorders, especially depression and anxiety. Anorexia includes a refusal to keep weight at a minimally normal level for age and weight, intense fear of gaining weight and denial of low body weight. Bulimia includes repeated episodes to binge eating (at least twice a week for three months), and recurrent inappropriate behaviors to avoid gaining weight such as vomiting, misuse of laxatives, or excessive exercise. 

 Suicide Warning Signs

• Talking about wanting to die or kill oneself
• Looking for ways to kill oneself, such as buying a gun
• Talking about feeling hopeless or having no reason to live
• Talking about feeling trapped or in unbearable pain
• Talking about being a burden to others
• Increasing the use of alcohol and drugs
• Acting anxious or agitated, or behaving recklessly
• Sleeping too little or too much
• Withdrawing or feeling isolated
• Showing rage or talking about seeking revenge
• Displaying extreme mood swings

Helping Students Cope

Youth will vary widely in terms of emotional expression. You may need to meet with some students individually or in small groups. It is also important to identify significant dates in advance; the anniversary of the death or the deceased person's birthday may be times students will need additional support and coping skills.

 Some ways to engage students in practical coping skills include:

• Simple relaxation and distraction skills; taking deep breaths or counting to 10. 
• Exercise.
• Identifying ways they've coped in the past.
• Making a list of things they're looking forward to.
• Focusing on individual goals.

It is recommended to keep the regular school schedule in place as much as possible. A regular routine is important for youth who may be struggling with the death and also those not affected by the death. It also is recommended when possible that services not be held on school grounds. A school administrator should attend the funeral. It also is advisable to encourage the parents of children attending the funeral to attend with their child.

While it is understandable that bereaved parents would wish to prevent another suicide, schools are encouraged to explain to parents that an assembly is not an effective approach to suicide prevention and may be risky because of students' reaction to the event and struggling with mental health issues of their own.

Information adapted from "After a Suicide: A toolkit for Schools" from the American Foundation for Suicide Prevention and the Suicide Prevention Resource Center.

The full toolkit can be found at: http://www.sprc.org/library/AfteraSuicideToolkitforSchools.pdf