School Response to Student Suicide

School Response to Student Suicide: Postvention

The emotional impact on family and friends following an adolescent suicide - and the school's response to a suicide - has not been the subject of the same level of intense research as have: a) the causes of suicides; and b) programs to prevent suicides. However, there is now an emerging body of solid research on what protocol a school can put into place, to be more prepared in the unfortunate circumstance of a teen suicide. Indeed, on the subject of tragedy, in the aftermath of the terrorist attacks of September 11, 2001, many schools and communities re-tooled their crisis/response plans for dealing with such threats. And yet, in many ways, the sudden, inexplicable death of a student can cause serious psychological ramifications to fellow students on a part with the shockwaves following an attack by terrorists. And hence, this paper analyzes literature that is available, relating to how a school can prepare an appropriate intervention crisis plan - postvention - to be put into effect well in advance of a tragedy, as well as issues closely tied to postvention. A good plan offers specifics in terms of how teachers, parents, administrators, and fellow students, can meet the sadness head-on, while avoiding confusion, misinformation, accusations, and emotions of rage or denial.

Why a need for postvention? The frequency of adolescent suicide is alarming.

Meanwhile, as to the seriousness of student suicide - and the resulting urgent need for schools to be planning ahead for crisis intervention - key facts are worthy of mention. Suicide is the third-leading cause of death among young people ages 18-24 (King, 1999). And even more updated surveys indicate that suicide "completion rates" more than doubled during the 1990s, and that among Caucasian adolescents, it is the 2nd leading cause of death" (Eckert, Tanya, et. al, 2003); for African-American adolescents, it is the third leading cause of death; further, Eckert asserts that 20.5% of high school students have "seriously considered" attempting suicide during a recent 12-month period, and that 7.7% reported making at least one suicide attempt in that same time span. Eckert goes on to report that, in 1998, "nearly five times more boys than girls in the 15-19-year-old range committed suicide," albeit the ejournal Health and Health Care in Schools (HHCS) states that "females contemplate and attempt suicide at much higher rates than males." The Center for Disease Control (CDC) reports that, "In 1999, more teenagers and young adults died from suicide than from cancer, heart disease, AIDS, birth defects, stroke, and chronic lung disease combined." The CDC also reports that "Persons under age 25 accounted for 15% of all suicides in the year 2000."

The ejournal HHCS claims there are approximately 11 adolescent suicides daily, while Dr. Carol Watkins (Northern Baltimore Psychiatric Associates) asserts that a youth "commits suicide every two hours" in America. Dr. Watkins also states that for every "completed suicide" there are 23 gestures and attempts by others, and that about 10% of those who attempt suicide later complete the act. Adding to those sobering statistics is the fact that in the U.S., over 2 million children and adolescents (3.4%) younger than 18 "have experienced the death of a parent" (Christ, Grace, et al., 2003).

Are professionals aware of postvention plans in their schools?

Meanwhile, in Ohio, a recent survey of 1,270 school administrators, counselors, and teachers (Wolfe, Jane, et. al, 1998), sought to determine not just the presence of postvention programs - but, just how many school professionals knew whether or not their school had such a plan. With cooperation from the State Department of Ohio, questionnaires were mailed to an equal number of schools in four quadrants. The overall response rate was 42%; and 491 of the respondents (40% of the total sample) reported that their school did indeed have postvention programs, while 750 (60%) said their school either did not have a plan (20%) or that they did not know (40%) if their schools indeed had a postvention plan. One in three professionals are not sure whether or not their school has postvention procedures planned? That is clearly not a very impressive statistic for educators, particularly in a time of high frequency of student suicides. (Not surprisingly, administrators [61%] and counselors [78%] were most likely to report their school had a plan.)

For those left behind - the need for well-thought-out postvention programs

Informative collaborative studies on postvention were recently compiled by the National Institute of Mental Health (NIMH) - with input from: CDC, NIH, HRSA, HHS, HIS, SAMHSA. The research is located on the National Strategy for Suicide Prevention group (NSSP) Web site, entitled, "Developing a Research Agenda for Suicide Survivors" (1990). The study states that suicide survivors, "compared to mourners of accidental, expected, and unexpected natural modes of death, had heightened feelings of responsibility and rejection, greater difficulty making sense of the death, and greater overall grief reactions."

The NIMH reports cites recent literature germane to the issue, which suggests that the following post-suicide subjects need further study: 1) understanding the "stigma" or "impact" of social response to suicide survivors; 2) the sense of guilt survivors feel for not having helped prevent the suicide; 3) the deterioration of family communication, possibly denial, following the death; 4) the parallel characteristics which are to be found within survivors, which led to the original suicide victim's demise, and the risks due to survivors' modeling of the victim's behaviors; 5) understanding how the burden on the survivors (of the same age) relates to their relationship with one another; 6) are there subgroups of survivors who face more burden, less burden, based on race, socioeconomic level, religion? 7) what support services are the most beneficial? 8) do survivors need help as they address shame and the "death stigma" coming from the community?

The NIMH study, while noting that many survivors later become "advocates" for suicide prevention, also pointed out that, unfortunately, many "first responders" (police, fire, rescue personnel, nurses, clergy, funeral home directors) are inadequately trained or prepared in their response to suicides. "Many survivors," the NIMH report continues, "have been further traumatized by insensitive first responders," and there are critical needs for better documentation of "both helpful and hurtful interactions" from those responders.

Step-by-step: how postvention projects should be done very instructive piece of literature on postvention (King, 1999), published in the American Journal of Health Studies, is among the most succinct and well-structured of several postvention program descriptions available. Keith A. King - who has done extensive research into adolescent and school issues with reference to suicide "myths" and prevention - points out that, postvention actions should be put in place not just when a student completes a suicide act, but when an act has been clearly threatened, or certainly when attempted. And further, King states that too often after an actual suicide, schools without postvention preparation fall into the trap of denial that the suicide happened, or, of refraining from discussing it for fear talk will cause "cluster" (e.g., copycat) suicides.

Teamwork. And, to be sure, cluster suicides are indeed a real threat following the death of a student; hence, once again, the urgent need for postvention. Who should be part of postvention planning? King says a team of school counselors, school psychologists, school social workers, school nurses, trained teachers, and resource individuals from area public health service agencies, should combine strengths and resources, meet frequently, and work out strategies. Their team role, at the outset, is to "minimize the trauma," and "provide overall coordination, communication, and implementation" of the postvention program. A systematic response is vital, King adds.

Inclusion of Teachers & Staff. Teachers need to be brought into the picture, once the postvention team is in place and ready to proceed in the unfortunate event of a suicide. "Teachers and school staff should be informed that some students may experience posttraumatic symptoms such as sadness, fear, anger, and shame" following a suicide. Those students may "act out truancy, substance use, and delinquency" as a method to "maladaptively adjust to the trauma." The students closest to the victim are the most likely to show the above-mentioned symptoms, and hence, should be watched carefully.

Available agency links. Well before any student commits suicide, the postvention team must be certain that the school knows which specific agencies and services that will need to be contacted after the suicide. These agencies include: police, ambulance, hospital, youth services, and mental health facilities, of course. Those phone numbers - and names of contact people - should be pre-published on a list which all key team members will have within their grasp.

Swift reactions. Timing is pivotal, when postvention action goes into play. "Waiting to enact the postvention activities after 24 hours can be suicidogenic," King writes. As was stated at the outset of this section of the paper, "the immediate goal" is to minimize the trauma and psychological distress to students and staff - an in so doing, derail the likelihood of cluster suicides.

Acting immediately means in a concerned, yet conservative and private way, towards the students. King asserts that the very day of the suicide, the principal needs to inform all teachers there will be a face-to-face session the following morning, ensuring that staff have the facts correct.

Each first period teacher the following day, has a duty to announce the death of the student, and inform students as to where and when counseling is available. "A straightforward announcement of the death," King suggests, "offering sympathy toward the surviving family members" should be offered. Returning to regular scheduled classwork as soon as possible is important, as well.

Psychological assistance. Counselors and other mental health professionals "should be made available" throughout the school - for staff and students - and if that means bringing in counselors from other schools, then that should be done. Earlier mentioned research - restated in King's paper - has shown that those close to the suicide victim tend to receive a great deal less support for their grief than do those close to victims of other kinds of death.

Do not glamorize suicides. Are big memorial services a good idea? King says absolutely not: "Many suicidologists consider special memorial services to be a glorification of suicide." With that in mind, schools should avoid any pressure to plan such an event, because "glamorizing the incident" could - and does - lead to cluster suicides. Adolescents, King suggests, "are more vulnerable than other age group to cluster suicides," so, it makes sense to present a more low-key type of event to pay homage to the victim. King believes the following ideas, gleaned from his own research, should be avoided: a permanent memorial, such as planting a tree is his or her honor, tends to glorify the act of suicide; or, making a plague to be placed in a place that is visible, is also undesirable; even the establishment of a scholarship fund - which could be done in a seemingly sincere way, would be highly inappropriate.

What then, would be appropriate for a suicide victim? "Some researchers suggest...a moment of silence at the start of the school day" - or a photo in the yearbook, or even a "fund-raiser for suicide-prevention programs" - would be far more appropriate, according to King's literature.

Outreach to parents. Another move the postvention team needs to make, King continues, is to make sure all parents of students receive the facts of the suicide, either through phone calls from PTA committees, or through other means. Further, "concerned parents should be encouraged to phone the principal's office to receive the facts surrounding the incident, and voice any concerns" they may have.

Making the right media moves. Who should respond to the media, following a student suicide? "One official spokesperson, and only one, should deal with the press," King writes. That person should be a mental health professional and a member of the postvention team. Moreover, the newspaper should be informed that cluster suicides - according to empirical data - are more likely to occur "when the story is placed on the front page in large headlines."

Good communication. The school board should also be officially notified of all facts of the suicide by the postvention team, through a written and an oral presentation. They should also be brought up-to-date on precisely how the postvention system has worked, when it went into place, and the effect it had on the school and the students.

Follow-up. Findings from authoritative research show suicide following a person's exposure to another suicide "was 2 to 4 times higher among 15-19-year-olds than older age groups," King reports. Hence, continuing sessions in groups or one-on-one are important, to allow students to fully express their ongoing feelings about the tragedy.

And, following the playing out of all the elements of a well-rehearsed and professionally-implemented postvention program, there nevertheless needs to be a formal follow-up ("post-mortem" is an inappropriate phrase in this instance) to assess how effectively the plan worked. Team members should be asked, and should think deeply about questions like: "What helped and what did not help?"

More ways to avoiding cluster suicides after an actual suicide

In a research article he published two years after the previously featured piece (King, 2001), King discusses the intervention that is necessarily in the event a student attempts - though doesn't carry out to completion - suicide. This is useful information for schools, if, following an actual school suicide, other youths become threats to perform cluster acts. King advises, when a student threatens suicide, then first of all, "Ensure student safety," and secondly, access that student's suicidal risk. There are three levels of risk, he notes: "extreme risk," "severe risk," and "moderate risk." In the "extreme" case, that student likely has a specific plan, either with a gun or another weapon, and "will not relinquish the dangerous instrument" willingly - at least initially. In this case, the school professional "should remain with the youth, stay calm, and encourage the student to talk and express feelings." The professional should not attempt to take the "lethal means" away, but instead should ask the student to voluntarily relinquish it. Once the weapon is securely out of the hands of the student, appropriate care for the student is the first order of business.

Identifying others who may become cluster candidates

One testing procedure which is being used by schools to determine, after a real suicide, if others may feel compelled to join the victim, is the two-stage screening and assessment process of the Suicidal Ideation Questionnaire (SIQ) (Eckert, et al., 2003). First, students are administered a class-wide, or school-wide, self-report SIQ screening survey. Any student who scores above "clinically significant levels" on the self-report measure then will receive individualized interviews with professionals, to further determine the risk for suicide. Does it work? Eckert writes: "Initial research into this area [self-report and individual interviews] has been promising."