The guidelines below were developed to help your district or school crisis team intervene with suicidal or self-injurous youth.

Instructions for Crisis Team

  1. Supervise the student and assign a “designated reporter.” Ideally, the chain of supervision begins with the perceptive, trained gatekeeper who escorts the student directly to the attention of a school crisis team member who will serve as the “designated reporter.” This is typically a school psychologist, counselor, social worker or nurse who has been trained to conduct suicide risk assessment. Under no circumstances should the student be allowed to leave school or be alone (even in the restroom) until a risk assessment has been completed and a plan has been generated. It may be appropriate to solicit the aid of collaborators to monitor the child while the crisis team member seeks a phone in private.
  2. Collaborate with administration or crisis team personnel. Many potentially difficult decisions will have to be made and having the support and consultation from an administrator and one other staff member (perhaps the school psychologist, nurse, counselor, or social worker) is both reassuring and prudent.
  3. Warn parents or protective services. Whether a child/adolescent is assessed to be low, moderate or high risk, parents or protective services must be notified in a timely fashion by the “designated reporter.”
  4. Provide resources to parents. Provide parents with “General Guidelines for Parents” handout and with additional school-site and local mental health resources as appropriate.
  5. Utilize law enforcement when appropriate. 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.

Assessing Risk in Suicidal Students

Questions to ask students:

  • Has the student thought about suicide (thoughts or threats alone, whether direct or indirect, may indicate LOW risk)?
  • Have they tried to hurt themselves before (previous attempts, repetitive self-injury may indicate MODERATE risk)?
  • Do they have a plan to harm themselves now (the greater the planning, the greater the risk)?
  • What method are they planning to use and do they have access to the means (these questions would indicate HIGH risk)?

Questions to ask parents, teachers, staff:

  • What warning signs(s) initiated the referral?
  • Has the student demonstrated abrupt changes in behaviors?
  • What is the support system that surrounds this child (the more the student feels isolated and alone, the greater the risk)?
  • Is there a history of mental illness (depression, alcohol and substance abuse, conduct or anxiety disorder, co-morbidity)?
  • Is there a history of recent losses, trauma or victimization?

Questions, Indicators, Levels of Risk and Interventions

LOW RISK (Ideation):

  • Sample student question: Have you ever thought about suicide (harming yourself)?
  • Other Indicators: current or recent thoughts; signs of depression; direct or indirect threats, sudden changes in personality, friends, behaviors; evidence of self harm in written or art work; dark internet websites and chat.
  • ACTIONS: Reassure and supervise student; warn parent; assist in connecting with school and community resources; suicide-proof environments; mobilize a support system; develop a safety plan that identifies caring adults, appropriate communication and coping skills and resource numbers.
  • Document all actions.

MODERATE RISK (Current ideation and previous behaviors):

  • Sample student question: Have you ever tried to kill (hurt yourself) before?
  • Other Indicators: previous attempts; recent mental health hospitalizations; recent trauma (losses, victimization); recent medications for mood disorders; alcohol and substance addiction; running into traffic or jumping from high places; repetitive self injury.
  • ACTIONS: See high risk.
  • Document all actions.

HIGH RISK (Current plan and access to method):

  • Sample student question: Do you have a plan to kill (harm) yourself today?
  • Other Indicators: current plan with method/access; finalizing arrangements: giving away prized possessions or written/e-mailed good bye notes; refusal to agree to a safety plan.
  • ACTIONS:
    • Supervise student at all times (including rest rooms).
    • Notify and hand off student ONLY to:
      • Parent or guardian who commits to seek an immediate mental health assessment.
      • Law enforcement.
      • Psychiatric mobile responder.
  • Document all actions.
  • Prepare a re-entry plan. All students returning from mental health hospitalization should have a re-entry meeting where parents, school and community mental health personnel make appropriate follow up plans.

*Lieberman, R., Poland, S. & Cassel, R. (2008). Suicide intervention. In Thomas, A. & Grimes, J., Best practices in school psychology V. Bethesda, MD: National Association of School Psychologists.

LA COUNTY RESOURCE
877.7.CRISIS or 877.727.4747
Suicide Prevention Center

NATIONAL RESOURCE
800.273.TALK (8255)
National Suicide Prevention Lifeline

Copyright 2010 by Los Angeles Unified School District Permission is granted for free reproduction and distribution for educational purposes with appropriate acknowledgment of authorship to the Los Angeles Unified School District.

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