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Crisis Management

Recognizing the Signs: What School Mental Health Professionals Can Do About Suicide and Self-Injury

By Christina Collins

In the everyday bustle of high school life, a student can have wounds— physical or emotional—that often go unnoticed. For social worker Cheryl Logston, working at the largest high school south of Chicago makes awareness of these issues even harder. "Our enrollment at Belleville Township High School-East is around 2,700 students," said Logston. "It is huge. Like a city of teenagers ... Our students represent a very diverse population, as you can imagine."

But even in a school as large and diverse as Logston's, some issues affect adolescents of all backgrounds. Two particularly serious issues among U.S. high school students are suicide and self-injury.

For youth between the ages of 10 and 24, suicide is the third leading cause of death, according to the Centers for Disease Control and Prevention. It results in approximately 4,500 lost lives each year. The incidence of suicide has remained relatively constant for the high school population over the years, and the need for suicide prevention programs has become more and more important. "I am proud to say that last year was our first year to offer the SOS program to our freshmen health classes," said Logston, referring to the evidence-based SOS Signs of Suicide Middle School and High School programs, provided by Screening for Mental Health, Inc. "I believe the staff orientation was hugely important in the program delivery. Our staff responded so positively—It was like they knew students were out there suffering and afraid, but they didn't know exactly what to do."

SOS Signs of Suicide is nationally recognized, easily implemented, and cost-effective, with separate programs tailored for middle school and high school students. The main teaching tool for both programs is a DVD showing students how to identify symptoms of depression and suicidality in themselves or their friends and encouraging help-seeking. The primary objectives of SOS are to educate teens that depression is a treatable illness and equip them to respond to a potential suicide in a friend or family member using the ACT approach: Acknowledge, Care, and Tell.

"My goal is to make the ACT approach part of the fabric—the culture—of our school for many things," said Logston. "There is such negativity around ‘telling'— like it is tattling. We have to break through that misconception and make ‘telling' feel part of the natural consequence for being a good friend or responsible person. I think high school students struggle with the concept of empathy. The SOS program opens that door and expands their thinking in that way."

The SOS program recently became the first-ever recipient of the John Kalafat Award in Applied Community Psychology, which was granted this year by the Society for Community Research and Action (SCRA), a division of the American Psychological Association. The SOS High School program is also the first suicide prevention program to be selected by SAMHSA for its National Registry of Evidence-based Programs and Practices because it addresses knowledge and attitudes about suicide and depression, while reducing suicide attempts.

"All the hard work and planning to implement a program like SOS pays off in that one split second when a student makes the decision to not take their life and ask for help," said Logston. "I know first hand what is left in the wake of such a tragedy from a school perspective."

The same can be said for self-injury, another increasingly prevalent issue among high school students. Self-injury is the nonsuicidal act of deliberately harming one's body in order to relieve emotional distress. A recent study published in Psychological Medicine found that out of 633 adolescents surveyed, 28% had engaged in moderate to severe nonsuicidal self-injury in the past year. Moreover, a study in the Journal of School Health found that 81% of school counselors reported working with a self-injurer during their career.

While self-injury is generally not about suicide, it is a risk factor for suicide because those who self-injure may become suicidal when their self-injurious actions fail to provide their usual distress reducing effect and catapult them into a suicidal crisis. According to Barent Walsh, PhD, executive director of The Bridge of Central Massachusetts, there are a number of ways that school psychologists, social workers, and counselors can better recognize the signs of self-injury. "The most obvious way," said Walsh, "is to learn what the signs are. Look for wounds such as cuts, burns, abrasions, scabs, and scrape marks, especially if the wounds are recurrent and if explanations are not credible."

To better educate students and adults about the signs of self-injury, Screening for Mental Health, Inc., has launched the new Self-Injury Prevention Program, a sister program to Signs of Suicide. Like Signs of Suicide, the Signs of Self-Injury program is designed for the high school environment and aims to train students to recognize the signs of self-injury and empower them to intervene when a friend is in distress. Simultaneously, the program lets students who self-injure know where they should turn within the school system and provides comfortable reassurance that a request for help will not be ignored. The Signs of Self-Injury program incorporates the same prevention technique—the ACT approach—introduced by the SOS program.

Both self-injury and suicide are growing concerns among school mental health professionals, especially as the statistics rise, and thus more and more U.S. schools are choosing to implement prevention programs addressing one or both of these problems. "They help us to take the stigma and the fear out of the equation," said Logston, "so that kids will come forward to get help for themselves or their friends. We have to do our best to provide the words, the avenues, the opportunities for these kids to make that bold step."

For more information or to register for the Signs of Suicide and Signs of Self- Injury prevention programs, visit www.mentalhealthscreening.org/schools.

Christina Collins is part of the communications team at Screening for Mental Health, Inc., a nonprofit in Wellesley, MA, that provides nationwide programs for mental health education and screening.