Suicide Prevention, Intervention & - PowerPoint Presentation

Slide1

Suicide Prevention, Intervention & Postvention in Schools

An Overview for Board LeadersSlide2

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.Slide3

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 schoolsSlide4

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)Slide5

Child and youth suicide

Brief OverviewSlide6

Suicidal behaviour

Non-Suicidal Self-Injury

a

deliberate attempt to cause injury to one’s 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 deathSlide7

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)Slide8

The complexity of Risk

Protective FactorsSlide9

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.Slide10

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.Slide11

Vulnerabilities – school/community

Learning problems

D

isengagement

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

bullyingSlide12

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 BehaviorSlide13

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

C

hange

in parents’ financial status

Serious

illness or injury in family member

Real

or perceived loss of status Slide14

ContagionOccurs 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 adolescentsSlide15

Circles of vulnerability

Population at Risk

Lahad

& Cohen, 2006Slide16

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)Slide17

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 broadlySlide18

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 safetySlide19

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 HealthSlide20

Youth suicide is complex and is often the result of many converging factors.

The explanations and the solutions are equally complex. Slide21

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 helpSlide22

Suicide prevention, intervention, & postvention

Strategies for Slide23

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 requiredSlide24

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 boardSlide25

SCHOOL RESPONSE TO SUICIDEFour components: Administrative Foundation, Prevention, Intervention &

Postvention

Slide26

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.Slide27

What is Suicide Prevention

?

Efforts to reduce the risk of suicidal thoughts and behavior amongst students in a systematic way Slide28

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 careSlide29

What is postvention?

Support for school communities in responding to suspected, attempted, or death by suicideSlide30

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)Slide31

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 factors…after 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 suicideSlide32

Prevention Strategy

Evidence

Early identification and treatment of mental health problems

Solid

School/community culture building

Solid

Adaptive

coping skill development

Solid

I

nformation dissemination / gatekeeper training

Promising

Screening and referral

Mixed

Youth engagement / peer helper programs

Mixed

Suicide awareness curricula for students

Mixed

Means restriction

Mixed

Crisis hotlines

Mixed

Media education programs

Insufficient Evidence

Effective

postvention

Insufficient

EvidenceSlide33

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 actionsSlide34

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 neededSlide35

Intervention strategies to avoidPeer 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 professionalsSlide36

Helpful postvention strategies

Understand the phases of

postvention

H

ave

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-careSlide37

Working through phasesThe 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

postventionSlide38

Media

Social MediaSlide39

Documentation of Ontario community mobilization response following a suicide clusterSlide40

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!!Slide41

Issues for board leadersChild and Youth SuicideSlide42

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 PartnersSlide43

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 expectationsSlide44

Suicidal behavior is a reality in your schools

Be proactive,

Be PreparedSlide45

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 approachSlide46

Recommended actionsBoard LeadersSlide47

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

)Slide48

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.Slide49

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 theseSlide50

Clarify rolesLeadership 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? Slide51

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

Pr

otocolSlide52

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 outlineCritical incident review formSlide53

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 communitySlide54

Capacity - buildingWhen possible, sequence capacity-building:

Senior Leaders

School Leaders

School Staff

Gatekeeper Training

Parents

Media

Students

Different audiences will have different knowledge needsSlide55

Communicate with staffCommunicate the protocol and related tools and templates

Board MH Team School Leaders

School Leaders School Staff

Some messages may need to go directly from the Board MH Team to all Staff and to mediaSlide56

Monitor, evaluate, refineDocumentation 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 Slide57

Sources, with ThanksMH 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 2008Slide58

Contact

School Mental Health ASSIST

Kathy Short, Ph.D.,

C.Psych

.

Director, School Mental Health ASSIST

Kathy.Short@hwdsb.on.ca

905-527-5092, x2634

School Mental Health

ASSIST

Équipe d’appui en santé mentale pour les écoles