Schools and Adolescent Suicide: What We Know and Don't Know. October 16, James Mazza, Ph.D.

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1 October 16, 2015 James Mazza, Ph.D. University of Washington Professor in School Psychology

2 Areas of Focus for Schools Prevention Intervention Re-entry Postvention

3 20 U.S. Youth Suicide Rates Annual Rate per 100,000 National Center for Health Statistics (2015)

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5 Schools Town Hall and Adolescent Suicide: Thursday What We at Know noon and Don't Know Current State of Mental Health in Schools

6 Suicidal Behavior Continuum I N V I S I B L E water line Death due to Suicide

7 Suicidal Ideation Morbid ideation, thoughts about death Wishes of never being born, better off dead Life s not worth living Suicide as retribution or punishment Thoughts of suicide (general & specific) (CDC, 2012)

8 Writing notes and/or will Giving away possessions or talking about it Collecting pills Suicidal Intent Definition: There is past or present evidence (implicit or explicit) that an individual wishes to die, means to kill him/herself, and understands the probable consequences of his/her actions or potential actions. Suicidal intent can be determined retrospectively and in the absence of suicidal behavior. Buying a gun in preparation for suicide (Gutierrez, 2011)

9 Any behavior that is perceived by the individual that is intended to result in death There are many types of suicide attempts Taking 5 aspirin Cutting wrists Suicide Attempt Putting a gun to the head (CDC, 2012)

10 Myths about Suicide Asking about suicide may cause suicidal behavior Those who attempt suicide get medical treatment Those who attempt suicide really want to die Suicide is not preventable Parents know if their child is suicidal If someone is talking about suicide they won t do it (Gould et al., 2010)

11 Addressing Risk & Protective Factors Previous Attempt and/ or exposure to suicide loss Co-Occurring Mental Disorder Drug & Alcohol Abuse Access to lethal means Unwillingness to seek help-stigma Feeling like a burden Safe environment at home and school Pets Hope for the future Cultural/ religious beliefs Isolation Effective treatment of mental, physical, and substance abuse disorders Sobriety SUICIDE Family, school & community support Restricted access to lethal means Cultural/ religious beliefs that discourage Learned suicide problem solving skills Academic, parental or financial pressure Bullying Impulsive/ aggressive tendencies Major transition stress (ex: into middle or high school & graduation Hopelessness & feeling trapped Barriers to treatment Physical pain or illness Recent loss from the person s perspective Graphic: Rosston, K. (9/05/14), presentation at: Western Montana Suicide Prevention Summit For more information see:

12 Warning Signs FACTS Feelings Actions Changes Threats Situations FACTS acronym adapted from Lifelines suicide prevention curriculum by Hazelden

13 Feelings Hopeless Depressed Angry Lonely Burdensome Anxious Trapped Lacking purpose Guilty Desperate

14 Actions Abusing alcohol/drugs Reckless behavior Aggression/fighting Self-harm/cutting Giving away possessions

15 Changes Personality Behavior Academic performance Eating habits & Sleep patterns Losing interest in social activities Withdrawing from family and friends Not taking care of personal appearance Sudden improvement after depressed for a long time

16 Threats Talking about death Who do you think would attend my funeral? Concerning statements You ll miss me when I m gone I can t take this anymore Making plans for suicide Researching suicide methods online Obtaining lethal means (e.g. buying rope) Threats can appear Verbally In writing: text, social media, etc. In actions: making a suicide plan

17 Threats on Social Media/Text

18 Situations Mental health or substance use disorder Recent losses: relationship, job, death of a loved one Rejection: from academic program, sports team, romantic partner, etc. Getting into trouble Changing circumstances: moving, graduating, changing schools Life situations: abuse, pregnancy, intimate dating violence Suicide exposure: suicide attempt or death of a friend or family member

19 Deaths due to Suicide in 2013 Suffocation 42.9% yr-olds Firearms 42.3% (CDC, 2015) Cut/Pierce 0.7% Fall/Jump (2.9%) Car/Trains (1.1%)

20 Death due to Suicide Suicide Attempts Female 16% Male 25% Male 84% Female 75% (CDC, 2015)

21 Non-fatal Self-Harm (n=411,128) Suicide (n=31,484) Cutting/piercing 2% Drowning Fall 1% 2% Cut/pierce 22% Fall 1% Firearm* 1% Poisoning 18% Poisoning 75% Inhalation/ suffocation 1% Suffocation 21% Firearm 55% (Miller, 2006)

22 Anxiety Disorders Substance Abuse Suicidal Behavior Depressive Disorders Personality Disorders

23 Current Theory of Suicide I. Interpersonal theory of Suicide Thwarted Belongingness Perceived Burdensomeness Serious suicide attempt or death by suicide Capacity to engage in Suicidal Behavior (Joiner, 2005; Van Orden et al., 2007)

24 Interventions Pharmacological Therapy SSRI s Prozac (caution with youth) School-Based Programs 1. Skills 2. Behaviors 1. DBT STEPS-A* 2. SOS X 2 3. Reconnecting Youth Cognitive Behavioral Therapy 1. Individual 2. Group 3. Dialectical Behavior Therapy (* being piloted regarding self-harming behavior )

25 U.S. Youth Suicide Rates why is the trend going back up? Annual Rate per 100,000 National Center for Health Statistics (2015)

26 Current Theory of Suicide I. How do we develop interventions to reduce these circles? Thwarted Belongingness Perceived Burdensomeness Serious suicide attempt or death by suicide Capacity to engage in Suicidal Behavior (Joiner, 2005; Van Orden et al., 2007)

27 Current Theory of Suicide II. Once developed, how do we integrate these interventions in schools? Thwarted Belongingness Perceived Burdensomeness Serious suicide attempt or death by suicide Capacity to engage in Suicidal Behavior (Joiner, 2005; Van Orden et al., 2007)

28 Interventions Pharmacological Therapy School-Based Programs Cognitive Behavioral Therapy SSRI s Prozac (caution with youth) What are the long-term implications for students on SSRI s? 1. Skills 2. Behaviors 1. DBT STEPS-A* 2. SOS X 2 3. Reconnecting Youth Who is implementing these programs? 1. Individual 2. Group 3. Dialectical Behavior Therapy Who is conducting DBT in schools? (* being piloted regarding self-harming behavior

29 General School-Based Setting MULTIPLE TIER SYSTEMS OF SUPPORT Out of School Placement Residential Treatment School + Integrated Mental Health Alternative School Tier III Tier II Intensified Tier I Intensive Services Special Education Response to Intervention (RTI) Tier IV Highly structured Educational services Tier VI Hospitalization Tier V Residential Treatment Within School Settings Tier III Indicated Tier II Selected Population Tier I Universal Population Tier IV Highly structured Therapeutic services Residential Treatment Center + Integrated School Services Tier III Tier II Intensified Tier I Intensive Services Outpatient Therapy School-Based Mental Health (SBMH) Should be talking to each other

30 A. How do we develop and integrate the SBMH multitiered systems of support? B. What would this look like in a school? C. What are the barriers for developing the complementary triangle? D. How do we develop and foster the re-entry into the school from Tiers IV, V, VI services? Tier III Tier II Intensified Tier I Intensive Services Special Education Response to Intervention (RTI) Within School Settings Tier III Indicated Tier II Selected Population Tier I Universal Population Tier III Tier II Intensified Tier I Intensive Services School-Based Mental Health (SBMH) Should be talking to each other

31 For Questions and Feedback James J. Mazza, Ph.D. Miller Hall, Box University of Washington Seattle, WA (206)