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October 1, 2001
Vol. 59
No. 2

The Shrink in the Classroom / The Suicidal Student

Suicide among youth in the United States has quadrupled during the past 50 years. As many as one in 10 students is seriously contemplating suicide at a given time, and each year 2 percent of girls and 1 percent of boys make suicide attempts. Girls are twice as likely to attempt suicide than boys, but boys are four times more likely than girls to actually end their lives (O'Carroll, Potter, & Mercy, 1994).
Educators increasingly see students who appear desperate or exhibit self-destructive behaviors. Worse, teachers feel increasing pressure to improve students' academic progress and test scores but may fear saying or doing something that might contribute to a student's suicidal behavior. Fortunately, recent studies of suicide provide a better awareness of risk factors, guidance for responding to potentially suicidal students, and advice for schools that are responding to a student suicide.

Recognizing Risk Factors

The most common precipitant to a student suicide is an interpersonal conflict or loss, usually with parents or a romantic relationship. Ongoing family conflict, physical or sexual abuse, and impending legal or disciplinary matters are also associated with suicidal acts. Intoxication and easy access to firearms strongly increase the likelihood of a suicide attempt and completion.
By speaking with people who knew an individual well in the months leading to the suicide, researchers have found that more than 90 percent of child and adolescent suicide victims had a diagnosable psychiatric disorder at the time of their death (Shaffer & Craft, 1999). In fact, most of these students had suffered significantly for at least two years before committing suicide.
Depression is the most common psychiatric disorder among youth who attempt or commit suicide; the risk for suicide increases if the student has relatives with depression or suicidal behavior. Most students with depression do not attempt or commit suicide, but among those who commit suicide, the interval between onset of depression and completion averages seven years, often with many suicide attempts during that time. Previous suicide attempts represent significant risk factors for future attempts, and students often make subsequent attempts in the next three months. Sometimes, suicide attempts increase following well-publicized suicides or fictional depictions of suicidal behavior.
Self-mutilation has also become more common. Students who mutilate themselves report that cutting or scratching makes them feel better briefly, giving them a sense of control and a way to express bad feelings. Different from suicidal behavior, repetitive self- mutilation still warrants attention; a more benign activity, for example, might be writing bad feelings on paper and then destroying the paper.

Addressing Suicidal Comments

Whenever an educator perceives a risk of suicide, he or she should treat it as an emergency and speak with school psychologists, guidance counselors, or social workers to decide on a course of action. Schools need a response protocol that clarifies who will be accessible to at-risk students and who will respond to student crises, including helping students cope following a student's attempted or completed suicide.
Educators can help mental health clinicians by describing specific behaviors—for example, "cried suddenly for no reason twice last week, wrote a story with a 10-line description of how a character committed suicide." If the student and family consent, educators and clinicians can collaboratively address the student's situation.
Even with well-designed protocols, however, teachers will still confront distressing behaviors from students. School staff members sometimes fear that bringing up suicide may precipitate an attempt, but the opposite appears to be true. Addressing frightening issues with students conveys a willingness to face any issue, together, and this cooperative effort actually decreases the isolation and hopelessness that contribute to suicidal acts. Simply discussing suicide, though, does not inoculate the student from subsequent harm, and follow-through with a mental health clinician is crucial.
All suicidal comments or acts represent an effort by the student to communicate distress to others. These students feel substantial anguish but can see no way to diminish their plight. They may also seize upon suicidal comments to punctuate the intensity of their feelings of love or hate. When students describe suicidal thoughts or self-destructive behaviors, the educator may want to ask what the student wishes or imagines would happen by this act. Posing this question diminishes the isolation that these students feel and suggests that clarifying the desires might make pursuing nondestructive alternatives possible.
Educators need not inquire into student break-ups, parental arguments, or mood states after drinking. Validating comments—"It really hurts when someone breaks up with you" or "That sounds scary"—are preferable to such reassurances as "It was probably for the best" or "You'll get over it." Allowing students to find solutions and to deal with past mistakes often diminishes the risks surrounding fears of humiliation.
After hearing suicidal comments repetitively, some are tempted to call the student's bluff by saying, "If you were serious, you'd have done it by now." This approach is particularly unhelpful, replacing an effort to understand the student's pain with a challenge that could have a tragic outcome.
Educators may feel uncomfortable when students ask personal questions, such as "Have you ever thought about suicide?" or "Did you ever drink alcohol or smoke pot to try to numb yourself to these kinds of feelings?" Answering these questions directly changes the focus, inappropriately, from student to teacher. Teachers may respond, "How would it change things if I had ever thought about suicide?" or "How would it be different if I had drunk alcohol or smoked pot to numb my pain?" This response encourages students to describe how they feel and focuses attention on the student rather than on the educator.
When a student has made suicidal comments or has attempted suicide, teachers often worry about how to discuss the matter with the student's peers. Classmates may comment on a student's excessive crying, self- mutilation, or absence during a hospitalization. Focusing on each student's concern is a helpful guiding principle. Alone after class, for example, the teacher might explore with a con-cerned classmate several ways to respond to an upset student, including devising a safe place for a crying student to go to regroup or acknowledging sadness by saying, "I'm sorry you're feeling bad right now—would you like to eat lunch with us later?" If a student is hospitalized, the teacher might ask, "What would make you feel better if you were out sick from school?" The class may want to send the student a card wishing a speedy recovery.

Responding to a Student Suicide

Unfortunately, suicide does occur among youth. To dispel the rumors that sometimes follow a student's suicide, a school staff member might discuss with the suicide victim's family what to convey to the victim's classmates and then inform students in small groups about the death. Educators can help students grieve appropriately, identify those having difficulty with the suicide, and provide students with a stable environment that acknowledges their distress but also allows for a return to a normal school routine.
Each student grieves at a different pace, so providing opportunities for a variety of responses is often helpful. Placing a card or book of remembrances for the family in a private spot for about a month allows students to address, in their own time, their feelings of loss; school staff can then review it for appropriate content and send it to the family. Memorials to the victim are rarely helpful because they suggest that the student is best remembered for a self-destructive act and also risk glorifying or validating suicide to other distressed students. Mental health or crisis intervention staff usually interview close friends of the student and those students who have a history of depression or suicide attempts (Fraser, 1998).
Suicide worries every student, teacher, and administrator. A school whose faculty share responsibility for recognizing and responding to the suicidal student and that designates the adults who can provide assistance to troubled students has a solid framework for supporting students and staff. Perhaps most important, teachers and other school officials need to help one another through these difficult circumstances. In this way, they can best serve the health of both faculty and students.
References

Fraser, J. (1998, Winter). Responding to suicide (Children, Youth, & Family Background Report No. 6). Pittsburgh, PA: University of Pittsburgh, Office of Child Development.

O'Carroll, P. W., Potter, L. B., & Mercy, J. A. (1994). Programs for the prevention of suicide among adolescents and young adults. Morbidity and Mortality Weekly Report, 43(RR-6), 1–7.

Shaffer, D., & Craft, L. (1999). Methods of adolescent suicide prevention. Journal of Clinical Psychiatry, 60(2), 70–74.

Steven C. Schlozman has contributed to Educational Leadership.

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