Times of Tragedy: Preventing Suicide in Troubled Children and Youth,
Tips for School Personnel or Crisis Team Members
Children and youth exposed to extreme trauma like the terrorist attacks
on the United States or a school shooting can be at increased risk of
suicide, particularly youngsters who have experienced a personal loss,
abuse, or previous traumatic event or who suffer from depression or
other mental illness. School personnel will need to be more vigilant
the weeks following a large-scale crisis, identify students who may
be at greater risk, and watch for warning signs. The following information
is a companion piece to After A National Tragedy: Preventing Suicide
in Troubled Children and Youth, Part I, which outlines
warning signs and tips for parents and teachers, available from the
National Association of School Psychologists online at www.nasponline.org.
(See also Save a Friend: Tips for Teens to Prevent Suicide,
also on the NASP website.)
Tips for School Personnel or Crisis Team Members
- Collaborate with colleagues. Having support and consultation
from an administrator and one other staff member (perhaps the school
nurse, counselor, or social worker) is both reassuring and prudent.
- Assign a designated reporter. Schools
should identify one or more individuals to receive and act upon all
reports from teachers, other staff and students about students who
may be suicidal. This individual is frequently the school psychologist,
counselor, nurse or social worker.
- Supervise the student. It is best to always inform
the student what you are going to do every step of the way. Solicit
the students 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 parent,
mental health professional or law enforcement representative can assume
- Mobilize a support system. Assessment of the student's
support system will contribute to evaluating the students risk.
It is often sensible to just ask the student, who do you want
or who do you think will be there for you now? and assist the
student achieving that support. It is important for students to feel
some control over their fate.
- No-Suicide Contracts. No-suicide contracts have been
shown to be effective in preventing youth suicide. In cases where
the suicide risk is judged to be low enough not to require an immediate
treatment (e.g., there is only ideation and no suicide plan), a no-suicide
contract is still recommended to provide the student with alternatives
should their suicide risk level increase in the future. Such a contract
is a personal agreement to postpone suicidal behaviors until help
can be obtained. The contract can also serve as an effective assessment
tool. If a student refuses to sign, they cannot guarantee they will
not hurt themselves. The assessment immediately rises to high risk
and the student should be supervised until parents can assume responsibility
in taking the student for immediate psychiatric evaluation.
- Suicide-proof the environment. Whether a child is
in imminent danger or not, it is recommended both the home and school
be suicide-proofed. Before the child returns home and thereafter,
all guns, poisons, medications, and sharp objects must be removed
or made inaccessible.
- Call police. All school crisis teams should have a
representative from local law enforcement. If a student resists, becomes
combative or attempts to flee, law enforcement can be of invaluable
assistance. In some cases they can assume responsibility for securing
a 72-hour hold which will place the youth in protective
custody up to three days for psychiatric observation.
- Documentation. Every school district should develop
a documentation form for support personnel and crisis team members
to record their actions in responding to a referral of a suicidal
A Suicide Intervention Model
Designated Reporters are often asked to make critical risk assessments
under extraordinary time constraints. Thus, it is important for a risk
assessment protocol to have a specific set of questions that will quickly
and reliably obtain needed information. Questions often used address
- What warning signs(s) initiated the referral?
- Has the student thought about suicide (thoughts or threats alone,
whether direct or indirect, may indicate low risk)?
- Has the student tried to hurt himself before (previous attempts
may indicate moderate risk)?
- Does the student have a plan to harm herself now?
- What method is the student planning to use and does he have access
to the means (these questions would indicate high risk)?
- What is the support system that surrounds this child (including
the parent in the risk assessment is critical to determining the adequacy
of the students support system)?
2. Duty to Warn Parents.
There is no question that parents must be notified. In addressing
this aspect of suicide intervention, four critical questions need to
- First, is the parent available?
- Second, is the parent cooperative?
- Third, what information does the parent have that might contribute
to the assessment of risk?
- Fourth, what mental health insurance, if any, does the family possess?
If the parent is available and cooperative and the student is
judged high risk, the psychologist or social worker must provide
parent(s) with community referral resources specific to where the family
resides and based on health insurance status. With parental permission,
the school psychologist should contact the agency, provide pertinent
referral information and follow up to insure the familys arrival
at the agency. If necessary, assist the parent in transporting the
student to the agency. The psychologist should obtain a parent signature
on a release of information form and assist school staff in working
with parents to develop a school support plan. All actions must be documented.
If a parent is unavailable and the student is judged high risk,
then, at the discretion of the school site administrator, two members
of the crisis team should escort the child to the nearest emergency
mental health facility and coordinate efforts with the agencys
Social Services to contact parent. Alternatively, school law enforcement,
local police or a mobile psychiatric response team may be asked to assist
in transporting the suicidal youth.
Some parents are reluctant to follow through on crisis team recommendations
to secure outside counseling for the suicidal child and may simplify
or minimize warning signals (e.g., "she's just doing this for attention").
Cultural and language issues are frequent. Give the parents appropriate
opportunity and encouragement to follow through before collaborating
with crisis team members on when to proceed to the next step. The school
crisis team must decide when it is appropriate to report a parent to
child protective services if their reluctance is truly negligence and
endangers the life of the child.
If it is determined that a parent is uncooperative and the student
is judged to be at high risk for a suicidal behavior, then local
law enforcement or child protective services should be contacted and
child neglect and endangerment report made.
If the parent is uncooperative and the student is judged low
risk for suicidal behavior, then it is recommended that the
parent to sign a Notification of Emergency Conference form
which serves to document that the parents have been notified of their
childs suicidal assessment in a timely fashion.
There will be occasions when a student does not want a parent
notified. When children are thinking of harming themselves,
they are not thinking clearly and, therefore, may not be the best judge
of what might be their parent's response. The crisis team has only
one decision to make: Will the child be placed in a more dangerous situation
by notifying the parent? In such a situation, child protective services
will typically be notified. The parents must still be notified and
it is the challenge to school personnel to elicit a supportive response
The parent often has critical information necessary to make an appropriate
assessment of risk. Thus it is critical to include parents in
the risk assessment. This information may include previous
school and mental health history, family dynamics, recent traumatic
events in the student's life, and previous suicidal behaviors. Interviewing
the parent will also assist the psychologist in making an appropriate
assessment of the support system that surrounds this student.
Finally, it is important to determine what mental health insurance
does the parent/family have? This information is essential
in directing families to appropriate community agencies. All modern
mental health intake interviews include questions regarding insurance
coverage and it is wise for the school psychologist to be aware of the
various local providers. If a student is directed to an emergency clinic,
they may later require emergency transport to an appropriate HMO provider.
This may not only further traumatize a suicidal student (because most
transports must be done under restraints) but also generate a bill of
great expense for the parent. It is certainly in the best interest of
the child and family to limit the trauma of any student in need of emergency
3. Duty To Provide Referrals.
It is critical to stress the importance of identifying and collaborating
with community agencies before the crisis occurs. It is recommended
that the school crisis team representative call the agency to provide
accurate information that the parent may omit or forget. School districts
have an obligation to suggest agencies that are non-proprietary or offer
sliding scale of fees.
4. Follow up and support the family.
Finally, it is important for school staff to provide ongoing modifications
to the students program, perhaps utilizing student study teams.
Resources for School Teams
National Association of School Psychologists
Center for Mental Health in Schools
National Victim's Assistance Organization
NASP represents 22,000 school psychologists and related professionals
throughout the United States and abroad. NASPs mission is to
promote educationally and psychologically healthy environments for all
children and youth by implementing research-based, effective programs
that prevent problems, enhance independence and promote optimal learning.
This is accomplished through state-of-the-art research and training,
advocacy, ongoing program evaluation, and caring professional service.
Modified from material posted on the NASP website, September 2001.
© 2002, National Association of School Psychologists, 4340 East
West Highway, Suite 402, Bethesda, MD 20814; (301) 657-0270, Fax (301)