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December 1, 2017
Vol. 75
No. 4

Getting Real About Suicide Prevention in Schools

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School Culture
Not long ago, my life was fairly normal. I had a loving husband and two smart kids. After 20 years as a classroom teacher and two years as an assistant principal, I felt like I finally knew enough to step into a leadership role. For the next five years, I served as principal of a K–8 school of about 800 students. I learned how to be an effective school leader and thrived in my belief that I was making a difference in the lives of the students I was responsible for. Every day was full of surprises. I looked forward to going to work each morning, knowing that planning and preparing for the unexpected was impossible, but preparing just the same.

Shattered

I never saw this one coming. On March 28, 2011, my life was shattered. Painfully, irrevocably shattered. As I was getting ready to head home at the end of the school day, my husband, Steve, called. He told me to come home right away. I asked what was wrong, but he wouldn't say. All he said was, "Just come now. Hurry."
With my stomach churning, I drove home as fast as I could, wondering what could have happened. I was totally unprepared for the reality of what I was to find when I got there. Fire trucks, police cars, and other emergency vehicles were scattered on our street. As I approached the front door, my husband stopped me and said the police wouldn't let us go inside. Then he told me why.
Steve had heard a gunshot inside the house just as he was getting home from work. Shocked, he searched the house until he found the body of our 21-year-old son. He had taken his own life moments before.
A senior at the local state university, Joss would have graduated a few months later with degrees in both psychology and biology. He was a passionate and brilliant student, fascinated by brain research, and had plans to continue his studies of neuroscience. Looking back, I believe he thought he would find clues to his own mental illness through his studies of the brain.

Picking Up the Pieces

The aftermath of that day was horrible. Both Steve and I struggled with bouts of intense grief for many months. We blamed ourselves for not being better parents and searched for reasons why we had not seen the signs that lead to our son's final choice. After reading many books and articles about suicide, we began to understand that Joss's death was the result of mental illness. The signs were there—we just didn't recognize them. Although we couldn't go back in time and change what happened, we wanted to help other families avoid becoming survivors of suicide loss. As I learned more about the causes and ways to prevent suicide, I vowed to do everything possible to raise awareness, attack the stigma, and teach others what I wish I had known before I lost my only son.

Warning Signs

With training and awareness, teachers, students, and other members of the school community can learn to recognize the signs of depression—by far the most common form of mental illness—and take action to address the needs of any student who may be suffering from it. Students with suicidal thoughts often give signals of their intentions. If students talk about wanting to kill themselves, write about being deeply depressed or sad, say they are a burden to their friends and families, or believe they have no reason to live—take it seriously!
It is an unfortunate myth that talking with someone about their suicidal thoughts will cause the person suffering to follow through with it. In fact, the opposite is true. Anyone who talks about suicide, even if only in veiled messages, wants someone else to know about it. Although they may not ask for help directly, they are delivering a message. A caring educator can start a conversation by asking, "Are you thinking about hurting yourself?"
In middle and high school students, the signs of depression are often non-verbal and tend to look like typical teenage behavior, such as sleeping too much or not enough. But when these behaviors last for several weeks or months, chances are there are deeper issues at play. Withdrawing from usual activities, excessive use of alcohol or drugs, giving away possessions, or displaying nontypical behavior are all associated with thoughts of suicide. Moods and attitudes also tend to change when a person is severely depressed. Young people may lose interest in a favorite activity or sport, seem more irritable or gloomy, or display uncharacteristic rage or anxiety.
Pay attention to the signs. And when a student expresses a sense of deep sadness or despair, never tell him or her to "just get over it" or "give it time, things will get better." For people who have never experienced real depression, it can be difficult to identify the feelings the sufferer is going through or how much mental pain they are in. If you see the warning signs, don't wonder about it—act. Refer the student to a school-based mental health professional, if available, or to the school nurse. These staff members will contact parents and refer them to an appropriate mental health service provider.

Awareness and Prevention

As Steve and I began searching for answers and looking for ways to heal, we became involved with the American Foundation for Suicide Prevention. Our goal was to learn as much as possible and share it with others. Teaching others what we had learned could save lives.
We gave suicide-prevention presentations to students, teachers, administrators, and community groups all over Arizona and shared research on recognizing the signs of depression or mental illness that could lead to suicide. We participated in events to raise awareness about suicide prevention, counseled recent survivors, shared tears and advice, and gave a lot of hugs to other survivors of suicide loss. It helped to know we were not alone in our loss, and we wanted to provide that support to others.
From that work, we've identified key steps schools can take to prevent suicide:
▪ Provide Mental Health First Aid training for at least two people on each campus. This training is available nationwide and teaches participants how to identify, understand, and respond to signs of mental illnesses and substance abuse disorders in their communities.
▪ Set up training in safeTALK for everyone willing to participate. This half-day program teaches participants to recognize and engage persons who might be having thoughts of suicide and connect them with community resources trained in suicide intervention.
▪ Plan training for students and staff members every year on recognizing signs of depression. Inform and include parents every step of the way. Examples of programs currently available include "Signs of Suicide" for middle and high school students and "More Than Sad" for students, parents, and educators.
▪ Increase awareness by participating in National Suicide Prevention Week or similar events in your community.
▪ Use evidence-based tools like the "Model School District Policy on Suicide Prevention," which was designed by The Trevor Project, American Foundation for Suicide Prevention, American School Counselors Association, and the National Association of School Psychologists. The Model School Policy details best practices for prevention, intervention, and "postvention." It also provides resources and suggestions for using the right language in school settings.
Most of the training available to schools and community members is free, paid for by grants or nonprofit organizations. In addition, many communities have groups dedicated to addressing mental illness and suicide prevention. Find them and connect with them.

Prevention in Practice

One of the best prevention programs I have seen takes place at a high school in Scottsdale, Arizona. Every year, the school invites a local suicide-prevention organization to talk to students. Every freshman, sophomore, junior, and senior participates in the training. Students watch a short video and are invited to join a class discussion, presented during regular class time by counselors and experienced volunteers. Students are typically silent at the end of the video, as most people are not comfortable talking about suicide and mental illness. Facilitators ask "what if" questions to encourage students to consider what they might do in different scenarios.
After the video and discussion, every student completes a brief paper screening form. The presenter sorts the screenings according to the responses, and before the end of the day, students whose results show symptoms of depression or other mental health issues meet individually with a counselor. (Measures are taken to protect their privacy and ensure they aren't singled out.) If an issue is identified, parents are notified, service organizations are contacted, and the student receives immediate professional support.
It is a daunting task for any school to provide extensive mental health training, and it takes time to pull it off well. Wouldn't it be great, though, if every school community—teachers, students, administrators, and parents—showed more compassion and understanding for students who struggle with depression, anxiety, and other mental illness? Taking time to tell a student that you noticed he or she seems troubled or referring a student to the school counselor are simple acts of kindness that could help save lives.
To be clear, not all mental illness leads to suicide, but it can affect a student's ability to function successfully in school. Having a caring adult who is willing to take the time to talk with students who are struggling and offer support can be the crucial factor that saves a child from making an impulsive choice they may not live to regret.

Stop the Stigma

People who suffer from depression (some of whom ultimately die by suicide) are often ashamed or embarrassed to let others know they are struggling with mental illness because of the stigma associated with it. For that reason, it is up to all of us not only to identify the signs and reach out to offer help, but also to fight the stigma.
Suicide is the second leading cause of death for Americans ages 15–34. Yet most people still refer to the act of suicide as if it were a crime, saying that someone has "committed" suicide. If a person dies from a heart attack, no one ever says they committed a heart attack. Suicide is no different. It is the result of a long illness that happens because the person is in so much pain that he believes he has no other way to end it.
We need to stop saying that a person "commits" suicide. They die by suicide or from a mental illness. We can help eliminate the stigma by treating a death by suicide as the end of an illness rather than an act of cowardice or a crime. School leaders can use this language during training presentations and written correspondences. If the school community is touched by a suicide death, administrators should use this language when they inform the school community about the death, with the family's permission.
Because of the stigma, suicides often go unreported, and the deaths are listed as accidents or the result of some other illness. This behavior limits the ability for communities to heal by talking openly about what happened, and prevents researchers of suicide prevention from collecting actionable data that may help them find better solutions.

The Future Is Hopeful

I spent much of my time as an educator in good neighborhood schools. Parents were involved with their children's education, and we rarely lacked volunteers. I never gave much thought to the problems of mental illness, other than sympathy for those afflicted, and largely ignored suicide because it had never touched my life. I have since learned that suicide occurs in all walks of life. It isn't selective about geography or socioeconomic status. It can happen anywhere.
As a teacher and school leader, I genuinely cared about my students and devoted myself to finding ways to encourage and support every one of them. But looking back now, I don't think that was enough. I was naïve about mental illness and was not knowledgeable about the signs of depression or mental illness in children.
Schools must address the social and emotional needs of children, starting on the first day they set foot in a school building, to help them to become successful students. When they do so, mental illness is more likely to be addressed, and suicide can be prevented.

EL Online

For a discussion of how to help students facing loss, see the online article "Helping Students Grieve" by Donna Marie San Antonio.

End Notes

1 Centers for Disease Control. (2015). 10 Leading Causes of Death by Age Group, United States – 2015. Retrieved from www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2015_1050w740h.gif

Theodora Schiro has contributed to Educational Leadership.

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