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Intervention Guidelines

The guide below is to give school administrators an idea of the steps that should be taken with regards to suicide prevention and suicide risk interventions, however this guide should not take the place of a robust suicide prevention program, or suicide risk assessment conducted by a school employed mental health professional. The questions included in these documents are sample questions that could be asked, but again, these are samples and not inclusive of all questions that should be asked, and do not replace the training necessary in conducting such risk assessments.

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Intervening with Suicidal 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 circumstance 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; having the support of 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 school-site and local mental health resources as appropriate.
  5. Utilize law enforcement when appropriate. All school crisis teams should include a representative from local law enforcement. If a student resists, becomes combative or attempts to flee, law enforcement can be of vital 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:

  • Have you thought about suicide? Thoughts or threats alone, whether direct or indirect, may indicate LOW risk.
  • Have you tried to hurt yourself before? Previous attempts or repetitive self-injury may indicate MODERATE risk.
  • Do you have a plan to harm yourself now? The more involved the planning, the greater the risk.
  • What method are you planning to use and do you 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 surrounding 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 loss, 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 of suicide; signs of depression; direct or indirect threats (including on social media); sudden changes in personality, friends, and behaviors; evidence of self-harm in art or written work; dark internet websites and chat.
  • Actions: Reassure and supervise the 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 suicide 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 and access to means; finalizing arrangements; giving away prized possessions or written or emailed goodbye notes; refusal to agree to a safety plan.
  • Actions:
    • Supervise student at all times (including restrooms).
    • Notify and hand off student ONLY to:
      • Law enforcement.
      • Psychiatric mobile responder.
      • Parent or guardian who commits to seek an immediate mental health assessment. (Can use a police escort if needed).
  • Document all actions.
  • Prepare a safety and support plan.
  • 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.

Toolkits

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Teacher and Mental Health Professional Roles in Prevention
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Preventing Suicide: A Toolkit for High Schools
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After a Suicide:
A Toolkit for Schools
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Toolkit for Health Promotion and Suicide Prevention

This Toolkit, from the Health Care Alliance for Response to Adolescent Depression, assists schools with promoting mental health, intervening in a mental health crisis, and supporting members of a school community after a loss to suicide.

Guides and Toolkits

Suicide Prevention Resources

Maintaining a Positive School Climate

  • Positive Behavior Interventions and Supports

    This is the Technical Assistance Center on Positive Behavioral Interventions and Supports. This website provides information for school districts on school climate and universal, targeted, and intensive behavioral supports for students.

Suicide Awareness Activities

  • Know the Signs

    Know the Signs is a California social marketing campaign emphasizing three key messages: “Know the signs. Find the words. Reach out.” This link takes you to resources and offers assistance to help increase knowledge of warning signs of suicide.

High School Clubs

  • National Alliance on Mental Illness On Campus (NAMI OC)

    The National Alliance on Mental Illness is a mental health organization focused on building better lives for those affected by mental illness. NAMI OC high school clubs are student-led clubs that raise mental health awareness and reduce stigma through peer-led education and campus activities.

Mental Health Awareness

  • Each Mind Matters

    Each Mind Matters is California’s mental health movement. This website includes resources and information to create your school’s campaign to raise awareness and reduce stigma associated with mental health disorders. This is important since many youth who experience suicidal thoughts also have a mental health issue.

Centers for Disease Control (CDC)

Other Resources