NASP Communiqué, Vol. 38, #3
November 2009
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.