Suicide Prevention & Response

I. PREVENTION

Recognizing the Warning Signs

Suicide and other self-destructive behaviors rarely occur without some warning signs. You, perhaps even more than parents of teens, can assess what is “normal” adolescent behavior and what may be an indication that something is wrong.

Here are some signs that a young person may be considering suicide:

  • A suddenly deteriorating academic performance. Teens who were typically conscientious about their school work and who are now neglecting assignments, cutting classes, or missing school altogether may be experiencing problems that can affect their academic success, behavior, and health and put them at risk of suicide.
  • Self-mutilation. Some young people resort to cutting their arms or legs with razor blades and other sharp objects to cope with emotional pain. Self-mutilation of this type is an unmistakable sign that something is wrong.
  • A fixation with death or violence. Teens may express this fixation through poetry, essays, doodling, or other artwork. They may be preoccupied with violent movies, video games, and music, or fascinated with weapons.
  • Unhealthy peer relationships. Teens whose circle of friends dramatically changes for no apparent reason, who don’t have friends, or who begin associating with other young people known for substance abuse or other risk behaviors may signal a change in their emotional lives. Their destructive behaviors may discourage more stable friends from associating with them, or they themselves may reject former friends who “don’t understand [them] any more.”
  • Volatile mood swings or a sudden change in personality. Students who become sullen, silent, and withdrawn, or angry and acting out, may have problems that can lead to suicide.
  • Indications that the student is in an unhealthy, destructive, or abusive relationship. This can include abusive relationships with peers or family members. Signs of an abusive relationship include unexplained bruises, a swollen face, or other injuries, particularly if the student refuses to discuss them.
  • Risk-taking behaviors. Risk-taking behaviors often co-occur and are symptomatic of underlying emotional or social problems. Such behaviors as unprotected or promiscuous sex, alcohol or other drug use, driving recklessly or without a license, petty theft, or vandalism, especially by young people who formerly did not engage in these activities, can be an indication that something is wrong.
  • Signs of an eating disorder. An eating disorder is an unmistakable sign that a student needs help. A dramatic change in weight that is not associated with a medically supervised diet may also indicate that something is wrong.
  • Difficulty in adjusting to gender identity. Gay, lesbian, bisexual, and transgendered teens have higher suicide attempt rates than their heterosexual peers. While coming to terms with gender identity can be challenging for many young people, gay and lesbian youth face social pressures that can make this adjustment especially difficult.
  • Bullying. Children and adolescents who are bullied, as well as those who bully, are at increased risk of depression and suicidal ideation (Kaltiala-Heino, Rimpela, Marttunen, Rimpela, & Rantanen, 1999).
  • Depression. Although most people who are clinically depressed do not attempt suicide, depression significantly increases the risk of suicide or suicide attempts. Symptoms of depression include the following:
  • A sudden worsening in academic performance
  • Withdrawal from friends and extracurricular activities
  • Expressions of sadness and hopelessness, or anger and rage
  • A sudden decline in enthusiasm and energy
  • Overreaction to criticism
  • Lowered self-esteem, or feelings of guilt
  • Indecision, lack of concentration, and forgetfulness
  • Restlessness and agitation
  • Changes in eating or sleeping patterns
  • Unprovoked episodes of crying
  • Sudden neglect of appearance and hygiene
  • Fatigue
  • The abuse of alcohol or other drugs as young people try to “self-medicate” their emotional pain

Some warning signs of suicide demand immediate action:

  • Talking or writing about suicide or death
  • Giving direct verbal cues, such as “I wish I were dead” and “I’m going to end it all”
  • Giving less direct verbal cues, such as “You will be better off without me,” “What’s the point of living?”, “Soon you won’t have to worry about me,” and “Who cares if I’m dead, anyway?”
  • Isolating him- or herself from friends and family
  • Expressing the belief that life is meaningless
  • Giving away prized possessions
  • Exhibiting a sudden and unexplained improvement in mood after being depressed or withdrawn
  • Neglecting his or her appearance and hygiene
  • Dropping out of school or social, athletic, and/or community activities
  • Obtaining a weapon (such as a firearm) or another means of hurting him- or herself (such as prescription medications)

II. RESPONSE

Responding to the Warning Signs

It takes time and courage to reach out to students on a personal level, but your interest can be a lifeline to a child in crisis. Young people—especially those with emotional or family troubles—need support, and school can be a vital part of that support. School may be the last positive social connection for young people from dysfunctional families or who are isolated from their peers.

When you observe behavior that indicates that there is a problem—whether the student is acting out, withdrawing, committing destructive or aggressive acts toward him- or herself or others, or exhibiting a fixation with death or morbid themes—take note and take action. Consult with your school counselor, principal, or nurse to ensure appropriate and quick assessment and treatment.

Many of the same signs that a student is at risk of suicide can also indicate that the student is at risk of (or is already experiencing) other problems, including emotional distress, mental illness (such as depression or bipolar disorder), violence, domestic violence or child abuse, academic failure, running away from home, or the abuse of alcohol or other drugs. You cannot always tell exactly what may be troubling a student and what the outcomes of theses troubles may be. But you can be aware of when something is wrong and take steps to get the student the type of help he or she needs. Below are some of the steps you can take to help students who may be at risk of suicide or of other problems that threaten their well-being.

Ask the Tough Questions Do not be afraid to ask a student if he or she has considered suicide or other self-destructive acts. Research has shown that asking someone if he or she has contemplated self-harm or suicide will not increase that person’s risk. Rather, studies have shown that a person in mental distress is often relieved that someone cares enough to inquire about the person’s well-being. Your concern can counter the person’s sense of hopelessness and helplessness. However, you need to be prepared to ask some very specific and difficult questions in a manner that doesn’t judge or threaten the young person you are attempting to help. For example:

  • I’ve noticed that you are going through some rough times. Do you ever wish you could go to sleep and never wake up?
  • Sometimes when people feel sad, they have thoughts of harming or killing themselves. Have you had such thoughts?
  • Are you thinking about killing yourself?

Be Persistent
A student may feel threatened by your concern. The student may become upset or deny that he or she is having problems. Be consistent and firm, and make sure that the student gets the help that he or she may need.

Be Prepared to Act You need to know what to do if you believe that a student is in danger of harming him- or herself. Many schools have procedures for this situation. If your school has such procedures, explain them to the student.

Do Not Leave a Student at Imminent Risk of Suicide Alone
If you have any reason to suspect that a student may attempt suicide or otherwise engage in self-harm, you need to remain with the student (or see that the student is in a secure environment, supervised by caring adults) until professional help can be obtained. The student’s well-being supersedes any promises of confidentiality you may have made to the student. Let the student know that you care, that he or she is not alone, and that you are there to help.

Get Help When Needed
If you believe that the student is in imminent danger, you, or another member of the school staff, should call 911 or (800) 273-TALK (8255). Tell the dispatcher that you are concerned that the person with you “is a danger to [him- or herself]” or “cannot take care of [him- or herself].” These key phrases will alert the dispatcher to locate immediate care for this person with the help of police. Do not hesitate to make this call if you suspect that someone may be a danger to him- or herself. It could save that person’s life.

Use Your School’s Support System 
School districts typically have crisis policies for working with suicidal or violent students, students who are at risk of suicide or violence, or other youngsters who are not in this acute state of crisis but still need support to stay in school and stay healthy. Familiarize yourself with these policies and programs and use them when appropriate. If your school doesn’t have such a policy in place, see “Create a comprehensive school crisis plan,” below.

Connect with Parents or Guardians 
If a troubled student opens up to you about self-destructive thoughts or actions, contact that student’s parents or legal guardian. Do not promise confidentiality to a child when it comes to issues regarding the child’s safety—but always talk privately with a student before letting others know of your concerns for the student’s safety. If you believe that contacting the parents or guardians may further endanger the child (if, for example, you suspect physical or sexual abuse), contact the proper authorities. In most states, teachers are “mandated reporters” and are required to report suspected child abuse.