Identify At-Risk Students

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A look at suicide prevention, from our Winter 2019 issue.

By Michele Faehnle

Imagine you are walking by a student’s desk and see him doodling in the margins of his notebook “I just want to die.” Or you are reading a poetry assignment in which a student writes about “falling into a great darkness” and wishing she was dead. What would you do? Should you say something to the student? Could he or she be serious about these comments? Can you help? Will it make a difference?

The short answer is yes; you can make an impact and help prevent suicide. As a teacher, you are in a unique and powerful role that can play an important part in helping students by knowing the signs of depression and suicidal behavior and how to appropriately respond.

Before a student takes his or her life, warning signs are often present. Students usually provide signals that they are in emotional distress through words and actions, which are opportunities to check in or intervene. Some are direct, and others require training to detect. Many times students will tell a friend, trusted teacher, coach, or counselor if they are struggling with depression.

Stop the myths

The first step in training school staff on suicide prevention is to dispel the myths about youth depression and suicide, according to Melanie Fluellen, licensed professional clinical counselor at Nationwide Children’s Hospital, and John Ackerman, PhD, clinical psychologist and Suicide Prevention Coordinator for the Center for Suicide Prevention and Research.

Myth: Talking about suicide increases the chances that someone will consider suicide for himself or herself.

Research indicates that discussing depression and suicide reduces the risk of suicide, and talking openly about it can lead to improvements in mental health.

Evidence-based programs, such as the SOS Signs of Suicide Prevention Program developed for middle schools and high schools, are designed to educate and engage school staff, parents, and students about mental health and suicide prevention.

Myth: Students who talk about killing themselves are less likely to follow through on actions that they state out loud.

Threatening one’s life is not a normal response to stress, and most people who die by suicide have given some sort of clue or warning. It is important for teachers to remember that all statements, behaviors, or warning signs related to suicide should be taken seriously, as they may indicate extreme emotional distress and increased chances of suicide. Never ignore a suicidal threat or comment.

Myth: If a person is set on killing himself or herself, nothing will stop them.

Although ambivalence toward death is common in students who are suicidal, most youth who are planning to take their own life do not want to die, but rather want their intense emotional pain to stop — and their view of the future and their options is constricted. Fortunately, this often improves with treatment and the resolution of a crisis. It is important to build a bridge of hope from crisis to recovery.

Myth: It is easy to identify a depressed or suicidal teen since they frequently cry and withdraw from others.
Although moodiness and withdrawal can be typical signs of depression, other signs include irritability, anxiety, low energy, or changes in eating or sleeping patterns. If you notice a change in a student’s behavior, it is worth following up with the student, stating your direct concerns and willingness to support them, and promptly notifying the student’s parents.

Identify risk factors

Knowing the risk factors for suicide is an important element of suicide prevention, according to Ackerman. The strongest suicide risk factors are mental illness, depression, previous suicide attempts, and drug and alcohol use. Other important risk factors to note are being male, access to lethal means (i.e., firearms), aggressive or impulsive behavior, history of sexual or physical abuse, family psychiatric history, history of bullying, distress related to sexual orientation or gender identity, chronic pain, certain medical conditions, and brain injury.

Ackerman also shared that children 12 and younger have other risk factors, including impulsivity (since their thoughts change rapidly and certain areas of their brains are still developing), difficulty solving problems, and not understanding the permanence of death.

For teachers, it is important to remember that no single event causes suicidality; rather, it is usually a combination of triggering events — such as a breakup, bullying, school problems, rejection or perceived failure, sudden death of a loved one, family stressors such as divorce, jail, or deployment, and suicide of a friend or relative — that lead a person who is already considering suicide to take action on these thoughts.

Only about one in four students with suicidal thoughts tells an adult they are contemplating suicide; therefore, it is important to know what signs to look for and how to respond. Fluellen lists the warning signs of suicide:

  • Wanting to be alone all the time
  • Decreased interest in preferred activities
  • Giving away important things
  • Risky or reckless behavior
  • An increase in energy following a period of depression
  • Sharing feelings, in person or on social media, of being a burden to others or wanting to die
  • Talking, reading, or writing about death or suicide in a school assignment
  • Increased anger or rage at classmates
  • Sudden change in academic performance or trouble concentrating
  • Searching for a way to kill themselves

Open the door

Dr Ackerman posed these conversation starters for teachers preparing to begin a conversation about suicide with a student:

  • “Do you ever get sad or lonely? What do you do to make yourself feel better?”
  • “Do you or your friends ever talk about hurting yourselves or not wanting to be alive anymore?”
  • “How would you respond if someone you knew was talking about hurting himself or herself?”

If you notice a student behaving differently, ask:

  • “I notice you have not been yourself lately. What’s bothering you?”
  • “You seem down and have been spending a lot of time alone. I am here for you, if you want to tell me about it.”

If a student approaches you and tells you that they are thinking about hurting themselves or wanting to die, Ackerman recommends these approaches:

  • “What is wrong? How can I help?”
  • “You can always talk to me about how you feel. We will get through this together.”
  • “I am going to be here for you, and I want to keep you safe.”
  • “You are brave for sharing this with me!”
  • “I want to listen; tell me more.”

Allowing the student to understand that you are there to listen and support them is key to helping them. You do not need to diagnose a child or assess their mental status. Try not to minimize their feelings or argue with them. It is your goal as the teacher to keep them safe, not fix the problem.

It is also important to plant seeds of hope. If a student is expressing suicidal thoughts, acknowledge their feelings, show that you care, and link them with an adult in a position to determine whether professional care is needed. Folks who may have this training include school psychologists, school counselors, and school nurses or social workers. Follow your school’s policy and procedures on what should be done if a student says they have been having thoughts of suicide and know who should be made aware.

Having a positive experience at school, connectedness to their school and class, and a sense of respect are important protective factors in preventing suicide. Belonging to a faith community is also a protective factor as it can foster hope and meaning in a student’s life and encourages positive relationships. Having reasons for living in a crisis is critical. In addition to noticing the signs of suicide, as a teacher, you can instill in students the truth that they are worthy to be alive. Students who are depressed can only see the negative and do not feel that they are loveable. Teachers can also encourage positive coping skills such as writing, relaxing, or playing sports. Encouraging the students to have good nutrition, sleep, and exercise habits is also an important piece in preventing and treating depression.

Prevention is key

The good news is that suicide is preventable! Open up the lines of communication between parents, students, and teachers if you recognize that a student may be struggling with depression and suicidal thoughts. Help students know where they can access resources such as counseling or suicide hotlines. Educate yourself on the signs of suicide and have a plan in place if you are presented with a student who needs help. Offer suicide-screening programs in your school to identify individuals at risk for suicide, confirm the risk, and guide their plan of care.

St. John Paul II gives great advice for all who may come into contact with those who suffer from depression and suicidal thoughts:

The role of those who care for depressed persons and who do not have a specifically therapeutic task consists above all in helping them to rediscover their self-esteem, confidence in their own abilities, interest in the future, the desire to live. It is therefore important to stretch out a hand to the sick, to make them perceive the tenderness of God, to integrate them into a community of faith and life in which they can feel accepted, understood, supported, respected; in a word, in which they can love and be loved. For them as for everyone else, contemplating Christ means letting oneself be “looked at” by him, an experience that opens one to hope and convinces one to choose life.

Addressing mental health issues with love and support, noticing and reporting atypical behavior, and supporting students is essential to preventing student deaths by suicide. We all play a valuable role.

Image credit: Shutterstock

Suicide facts and figures

The suicide rate has increased steadily from 1999–2016.

Suicides among young girls age 15–19 doubled from 2007–2016.

Suicide is the second-leading cause of death in the United States for children age 10–19.

The primary cause of suicide is depression.

Statistics from the Centers for Disease Control (CDC) show that children even 12 years old and younger plan, attempt, and die by suicide.

Suicide was the fourth-leading cause of death for 12-year-olds in 2008.

For more information, visit the Nationwide Children’s Hospital website “On Our Sleeves: A Movement to Transform Children’s Mental Health.”

If you have thoughts of suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741 where a live, trained specialist will respond to you.

Michele Faehnle, RN, BSN, is the school nurse at St. Andrew School, Columbus, Ohio, and co-author of four books. Pray Fully is her latest book.

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