Preventing Suicide: Guidelines for Administrators and Crisis Teams

School personnel have a legal and ethical responsibility to recognize and respond to suicidal thinking and behavior. Schools must have clear policies and procedures for what to do, as well as trained school-employed mental health professionals and crisis response teams. Although many suicidal children and adolescents do not self-refer, most show some warning signs. Never ignore these signs. Suicide prevention should be an integral component of a multi-tiered system of mental health and safety supports.

Assembling a Crisis Team

A trained school safety and crisis response team is essential to being able to identify and intervene effectively with students who are at risk of suicidal behavior. At a minimum, the team should include an administrator, school-employed mental health professional, school security personnel, and other appropriate school personnel. Each crisis response team member needs to have clearly defined roles and responsibilities.

The crisis response team is responsible for developing and implementing suicide risk assessment, intervention and postvention policies and procedures. Sometimes these policies are developed at the district level by a district crisis response team.

The crisis response team should assign one or more individuals as a "designated reporter" to receive and act upon all reports from teachers, other staff and students about students who may be suicidal. This individual should be a school-employed mental health professional (e.g., school psychologist, counselor, nurse or social worker).

All school crisis response teams should have a representative from local law enforcement. If a student resists, becomes combative or attempts to flee, assistance from law enforcement is essential. In some jurisdictions, law enforcement can also be of help to obtain a "72-hour hold," which will place the youth in protective custody for psychiatric observation and treatment. In other jurisdictions, the community mental health center, child protective services, and/or calling 911 is required if the youth needs to be placed in protective custody and parents are unable to safely transport and/or are uncooperative. It is important to know the procedures for your jurisdiction.

All staff should receive training annually on the warning signs and referral procedures for students who display signs of suicidal thinking and behavior. Students should also receive instruction about risk factors, warning signs, and how to get help for themselves or a friend. This training can be part of the curriculum or a comprehensive suicide prevention program, but should be delivered by qualified credentialed educators.

Prevention Measure

Providing a safe, positive, and welcoming school climate; and ensuring that students have trusting relationships with adults serves is the foundation for effective suicide prevention efforts. Schools should have mental health supports that are explicitly connected to both school safety and learning outcomes. Ideally they also should implement a comprehensive empirically supported suicide prevention program [e.g., Signs of Suicide (SOS)]. Schools should make use of a well-publicized tip line for students to call or text with any concerns.

Bullying and suicide-related behaviors have a number of shared risk factors including mental health challenges (e.g., depression, hopelessness, and substance use/abuse). Thus, schools would be well served by adopting an integrated approach to violence prevention with both peer-directed and self-directed violence addressed in the design and implementation of programs, policies, and procedures. Youth who report frequently bullying others and those who report being frequently bullied are at increased risk for suicidal thoughts and behavior. Bully-victims (those who report both bullying others and being bullied) are at the highest risk for suicidal thoughts and behaviors. Keep in mind the relationship between bullying and suicide is more complex and less direct than it might appear. While bullying may be a precipitating event, there are often many other contributing factors, including underlying mental illness.

Prevention efforts should also address non-suicidal self-injury (NSSI or "cutting"). While the behavior is typically not associated with suicidal thinking, it is a red flag that someone is distressed and does increase the risk for suicidal thinking and behaviors. It is important that school staff learn to recognize the signs of NSSI, including cuts, burns, scratches, scabs, and scrapes, especially those that are recurrent and if explanations for the injuries are not credible. Suicide risk assessment should always be a part of intervention with the student who displays NSSI.

Identification and Intervention

Early identification and intervention are critical to preventing suicidal behavior.When school staff become aware of a student exhibiting potential suicidal behavior, they should immediately and escort the child to a member of the school's crisis response team for a suicide risk assessment (i.e., the "designated reporter"). They should not "send" the student on their own. If the appropriate staff is not available, 911 should be called. Typically, it is best to inform the student what you are going to do every step of the way. Solicit the student's assistance where appropriate. Under no circumstances should the student be allowed to leave school or be alone (even in the restroom). Reassure and supervise the student until a 24/7 caregiving resource (e.g., parent, mental health professional or law enforcement representative) can assume responsibility.

Designated members of the school crisis team should conduct a suicide risk assessment. The purpose of the assessment is to determine the level of risk and to identify the most appropriate actions to ensure the immediate and long-term safety and well-being of the student. This should be done by a team that includes a school-employed mental health professional.(See NASP's handout on ,a href="/resources-and-publications/resources/school-safety-and-crisis/preventing-youth-suicide/preventing-suicide-guidelines-for-administrators-and-crisis-teams#" >threat assessment for guidance on this topic.)

Caregiver notification is a vital part of suicide prevention. The appropriate caregiver(s) must always be contacted when signs of suicidal thinking and behavior are observed. Typically this is the student's parent(s); however, when child abuse is suspected protective services should be contacted. Even if a child is judged to be at low risk for suicidal behavior, schools may ask caregivers to sign a form to indicate that relevant information has been provided. Regardless, all caregiver notifications must be documented. Caregivers also provide critical information in determining level of risk. Whether a student is in imminent danger or not, it is strongly recommended that lethal means are (i.e. guns, poisons, medications, and sharp objects) are  removed or made inaccessible.

Refer to community services if warranted. Suicidal thinking and behaviors can also occur outside of school hours. Thus, referral options to 24 hour community-based services should be identified in advance. It is best to obtain a release from the primary caregiver to facilitate the sharing of information between the school and community agency and it is highly recommended the school contact the agency to share critical information. School districts have an obligation to suggest agencies that are non-proprietary or offer sliding scale of fees.

Help the student to develop a safety plan. Generally speaking no-suicide contracts have been shown to be ineffective and are no longer recommended. However, helping the student to develop a written list of coping strategies and sources of support that can be of assistance when he or she is having thoughts of suicide (i.e., a safety plan) is recommended. Suicide prevention hotlines (e.g., 800-273-TALK) and the app MY3 (my3app.org) can be helpful elements of such a plan.

Schools are legally responsible for documenting every step in the assessment and intervention process. Such documentation ensures that protocols were followed. Every school district should develop a documentation form for support personnel and crisis response team members to record their suicide intervention actions and caregiver communication. Student information must be kept confidential but there are exceptions to FERPA when safety is of concern. Staff responsible for the safety and welfare of the student should be provided with the information necessary to work with the student and preserve the safety. School staff members do not need clinical information about the student or a detailed history of his or her suicidal risk or behavior. Discussion among staff should be restricted to the student's treatment and support needs.

Keep tabs on the rumor mill (including social media). If you hear or see something credible, refer the student to a school-employed mental health professional or crisis response team member. At the same time, gossip about particular incidents and students should also be discouraged. For more information on conducting a suicide intervention, see handout "A Suicide Intervention Model."

Postvention

Following a suicide, school communities must strike a delicate balance. Students should have an opportunity to grieve, but in a way that does not glorifying, romanticizing or sensationalizing suicide, which may increase suicide risk for other students.

Confirm facts. Confirm the facts related to the death with the family and/or police. Inform other schools in the district with students related or close to the deceased. Contact the family to offer condolences, ask what the school can do to help, offer resources, and to discuss communication with the school community. Protect and gather the personal effects of the deceased for the family and/or the police. Pay close attention to other students (and staff) who may also be at risk of suicidal behavior.

Resources needed. In some situations, schools may have adequate resources to handle the aftermath of a suicide. However, it is critical that schools assess the impact of the suicide on the school community to determine the level of postvention support needed.  Factors to consider include how well known the student was, if the suicide was public (i.e., occurred at school), and/or if the deceased had shared his/her suicidal intentions with others (particularly to large numbers of other students via social media). These factors generally increase the impact and thus the potential postvention needs of members of the school community.

Contagion. Suicide contagion occurs when suicidal behavior is imitated.  The effect is strongest among adolescents: they appear to be more susceptible to imitative suicide than adults, largely because they may identify more readily with the behavior and qualities of their peers. Guilt, identification, and modeling are each thought to play a role in contagion.  Sometimes suicide contagion can result in a cluster of suicides. Studies indicate that 1-5% of all suicides within this age group are due to contagion (100-200 teenage cluster suicides per year).

Suicide postvention strategies designed to minimize contagion include avoiding sensationalism or giving unnecessary attention to the suicide, avoiding glorifying or vilifying of suicide victims, and minimizing the amount of detail about the suicide shared with students.

If there appears to be contagion, school administrators should consider taking additional steps beyond the basic crisis response, including stepping up efforts to identify other students who may be at heightened risk of suicide, collaborating with community partners in a coordinated suicide prevention effort, and possibly bringing in outside experts.

Memorials. Memorials in particular run the risk of glamorizing suicide and should thus be implemented with great care. Living memorials are recommended such as making donations to a local crisis center, participating in an event that raises awareness about suicide prevention, or providing opportunities for service activities in the school that emphasize the importance of student's taking care of each other.

Care for the caregiver. It is important that administrators and crisis team members not underestimate the potential impact that a suicide can have on school staff members. School leaders should promote a culture in which both the students and the adults in the building feel comfortable asking for help and/or to take a break. Providing contact information and encouraging staff to meet their own mental health needs is an important first step in ensuring that staff are adequately supported.

Media. In general, news media outlets will not cover suicide as a news story unless the death occurs in public or the victim is a public figure.  If a suicide is reported by news media, reporters should simply inform their audience of the death without sensationalizing it.  Pictures of the deceased and the use of the word suicide in the headline are discouraged.  News stories should note that most people who die by suicide have mental health challenges and exhibit warning signs, and these should be included in the story or in a sidebar. Suicide should be portrayed as a public health issue and the story should offer both hope and information about available suicide prevention and mental health resources available in the community.


© 2015, National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814; (301) 657-0270, Fax (301) 657-0275; www.nasponline.org

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