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
Youth Suicidal Behavior and Postvention
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.
Youth Suicidal Behavior and Postvention
FeelingsActionsChanges Threats SituationsFACTS acronym adapted from Lifelines suicide prevention curriculum by Hazelden http://www.hazelden.org/web/public/lifelines.page
FACTS
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Youth Suicidal Behavior and Postvention
• Hopeless• Depressed• Angry• Lonely• Burdensome• Anxious• Trapped• Lacking purpose• Guilty• Desperate
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Youth Suicidal Behavior and Postvention
• Abusing alcohol/drugs• Reckless behavior• Aggression/fighting • Self-harm/cutting• Giving away possessions
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Youth Suicidal Behavior and Postvention
• 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
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Youth Suicidal Behavior and Postvention
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
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Youth Suicidal Behavior and Postvention
Do not reproduce or distribute w ithout w ritten permission from James J. Mazza © Mazza Consulting, 2018
Youth Suicidal Behavior and Postvention
• 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
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Youth Suicidal Behavior and Postvention
Look for warning signsEmpathizeAsk about suicideRestrict lethal meansNext level of care
LEARN
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Youth Suicidal Behavior and Postvention
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
Youth Suicidal Behavior and Postvention
“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.”
D d di ib i h i i i f J J M © M C l i 2016
Youth Suicidal Behavior and Postvention
Sometimes when people are ________, ________, and ________, they are thinking about suicide. Are you thinking about suicide?
D d di ib i h i i i f J J M © M C l i 2016
Youth Suicidal Behavior and Postvention
“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”
D d di ib i h i i i f J J M © M C l i 2016
Youth Suicidal Behavior and Postvention
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
D d di ib i h i i i f J J M © M C l i 2016
Youth Suicidal Behavior and Postvention
Components for Reducing Suicidal Behavior
Prevention
Intervention
Postvention
Youth Suicidal Behavior and 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
Youth Suicidal Behavior and Postvention
** Note: Explored in detail during morning breakout sessions
Components for Reducing Suicidal Behavior
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
Youth Suicidal Behavior and Postvention
Components for Reducing Suicidal Behavior
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.
Youth Suicidal Behavior and Postvention
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.
Youth Suicidal Behavior and Postvention
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.
Youth Suicidal Behavior and Postvention
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.
Youth Suicidal Behavior and Postvention
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.
Youth Suicidal Behavior and Postvention
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.
Youth Suicidal Behavior and Postvention
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
Youth Suicidal Behavior and Postvention
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
Youth Suicidal Behavior and Postvention
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
Youth Suicidal Behavior and Postvention
III. Specific DO’s and DON’Ts for Suicide Postvention
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
Youth Suicidal Behavior and Postvention
III. Specific DO’s and DON’Ts for Suicide Postvention
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
Youth Suicidal Behavior and Postvention
III. Specific DO’s and DON’Ts for Suicide Postvention
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
Youth Suicidal Behavior and Postvention
III. Specific DO’s and DON’Ts for Suicide Postvention
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
Youth Suicidal Behavior and Postvention
III. Specific DO’s and DON’Ts for Suicide Postvention
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
Youth Suicidal Behavior and Postvention
III. Specific DO’s and DON’Ts for Suicide Postvention
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
Youth Suicidal Behavior and Postvention
III. Specific DO’s and DON’Ts for Suicide Postvention
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
Youth Suicidal Behavior and Postvention
III. Specific DO’s and DON’Ts for Suicide Postvention
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
Youth Suicidal Behavior and Postvention
III. Specific DO’s and DON’Ts for Suicide Postvention
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
Youth Suicidal Behavior and Postvention
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
Youth Suicidal Behavior and Postvention
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
Youth Suicidal Behavior and Postvention
National Resource and Information Numbers
American Association of Suicidology
www.suicidology.org
202 237-2280
National Suicide Prevention Lifeline
800 273-TALK
Youth Suicidal Behavior and Postvention
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
Youth Suicidal Behavior and Postvention
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Youth Suicidal Behavior and Postvention
James J. Mazza, Ph.D.Miller Hall, Box 353600University of WashingtonSeattle, WA 98195-3600(206) [email protected]
Business Card
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Youth Suicidal Behavior and Postvention