James Mazza, Ph.D. University of Washington 19th Annual Suicide Prevention Conference Provo, Utah: December 3, 2018
Disclosure Statement: I am the first author of the DBT Skills in Schools book. My wife is the second author. We receive royalties on the sale of the books. Guilford Press, INC
Program Objectives: 1. To learn the different components of FACTS & LEARN. 2. To recognize the different levels of prevention and intervention for youth regarding suicidal behavior. 3. To learn and identify different intervention and postvention strategies. 4. To determine what postvention strategies make sense for your current setting.
Do not reproduce or distribute without written permission from James J. Mazza Mazza Consulting, 2018 FACTS Feelings Actions Changes Threats Situations FACTS acronym adapted from Lifelines suicide prevention curriculum by Hazelden http://www.hazelden.org/web/public/lifelines.page
Hopeless Depressed Angry Lonely Burdensome Anxious Trapped Lacking purpose Guilty Desperate Do not reproduce or distribute without written permission from James J. Mazza Mazza Consulting, 2016
Abusing alcohol/drugs Reckless behavior Aggression/fighting Self-harm/cutting Giving away possessions Do not reproduce or distribute without written permission from James J. Mazza Mazza Consulting, 2018
Personality Behavior Academic performance Sleep patterns Eating habits Losing interest in social activities, sports, hobbies Withdrawing from family and friends Not taking care of personal appearance Sudden improvement after seeming depressed for a long time Do not reproduce or distribute without written permission from James J. Mazza Mazza Consulting, 2018
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 Do not reproduce or distribute without written permission from James J. Mazza Mazza Consulting, 2018
Do not reproduce or distribute without written permission from James J. Mazza Mazza Consulting, 2018
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 Do not reproduce or distribute without written permission from James J. Mazza Mazza Consulting, 2018
LEARN Look for warning signs Empathize Ask about suicide Restrict lethal means Next level of care Do not reproduce or distribute without written permission from James J. Mazza Mazza Consulting, 2018
Feelings of depression, anxious, hopelessness, feelings of being out of control Actions: abusing alcohol/drugs, self-harm, previous suicidal behavior Changes: sudden changes in behavior, relationships, elation from deep sadness, can go in both directions Threats: talking about death, concerning statements, making plans for suicide, making threats (verbally, social media, etc) Situation: recent loss of a relationship or loved one, mental health issues, rejection from a team or relationship, major life event, getting into trouble
I am concerned about you and what maybe going on I am not here to judge, I just want to help and listen I really care about you. I want to help. You mean a lot to me and I m worried about you.
Sometimes when people are,, and, they are thinking about suicide. Are you thinking about suicide?
Do you have access to a gun? who can hold onto your gun for you? Lets make that happen where can you store the ammunition in a safe place? Do you have access to pills and/or alcohol? Who can help you remove these from you home? Lets make that happen
Talk to your school psychologist, counselor, social worker, or nurse Call the National Suicide Prevention Lifeline: 1-800-273-8255 (TALK) Trevor Line (LGBT): 1-866-488-7386 Crisis Chat www.crisischat.org Crisis Text www.crisistextline.org
Components for Reducing Suicidal Behavior P r e v e n t i o n I n t e r v e n t i o n P o s t v e n t i o n
Upstream Strategies for Suicide Prevention Prevention: The process of trying to reduce the likelihood of students/youth experiencing any suicidal behavior. Universal level. Good suicide prevention programs do not need to necessarily focus on suicide Drug and Alcohol Prevention Risky Sex Bullying Prevention **Coping strategies and decision-making ** Note: Explored in detail during morning breakout sessions
Components for Reducing Suicidal Behavior Intervention: The process of trying to reduce the severity and/or emotional distress that is contributing to students/youth experiencing any suicidal behavior. Selective & Indicated levels. These programs address warning signs, myths and teach good listening skills ASIST Applied Suicide Intervention Skills Training QPR Question, Persuade, and Refer SOS Signs of Suicide RY Reconnecting Youth
Components for Reducing Suicidal Behavior Postvention: The process of intervening after the death of a suicide to prevent possible contagion effects (i.e., additional suicides), thus, suicide postvention is also a form of suicide prevention. Because of its preventive focus postvention procedures are viewed as a critical and essential element of school-based suicide prevention.
Postvention 1 st Day before school starts 1. Implement School Crisis Plan use calling tree to contact all school personnel. 2. Set up school personnel meeting for early the next day before school starts. Go over procedures on how the school will function, resources available to students & staff, and how this information will be disseminated: small groups recommended. 3. School needs to focus on feelings and emotion rather than academics otherwise school will be viewed as not caring. 4. Provide opportunities for school personnel to vent their feelings and frustrations before the school day starts and before they have to deal with the emotions of their students. 5. Provide a written announcement for teacher regarding the death of the student: facts and school & community resources.
Postvention 1 st Day School Starts 1. Announcement regarding the death of the student should occur at the same time. Teachers should read the provided sheet. Principal should use the PA system to inform teachers when they should read their announcements. 2. Within the classrooms, teachers should provide students with the facts, resources available today, and the school day structure. 3. Let students talk about their feelings. Important to emphasize that no one is to blame. The person with all the answers is unfortunately no longer with us. 4. Offer support to the family and work with them regarding funeral arrangements. School & funeral should not compete for students time. 5. Memorials and plaques should be downplayed. Media contact needs to be carefully planned and follow recommended guidelines.
Postvention 1 st Day (Cont) 6. Have crisis team, counselors, and school psychologists identify any students who seem to be at particularly high risk for suicidal behavior (i.e., close friends, siblings, girlfriend/boyfriend, & past attempters). 7. School schedule should be reimplemented after school principal, staff, and crisis team feel appropriate time has been given for expression of feelings and communication. Tests should be rescheduled for another day & no repercussions for missing class. 8. Empty chair strategy following student s schedule crisis response person or person trained in handling crisis situations. 9. A designated room/office should be available for students still struggling with this event. This office should be available for these students for the rest of the week.
Postvention 2 nd & 3 rd Days 1. Crisis team remains in the school and counselors/school psychologist should still offer small group discussions if students come down to the designated room/office. 2. Announcements in the morning should include the available of resources for students who continue to struggle with the tragic news. If a funeral time has been reached by the family, included this as well. Ideally, the best time is in the late afternoon or evening. 3. Counselor & school psychologists should develop a checklist of those who are still struggling and check-in with those people each day. 4. Maintain contact with family offer support and provide community resources for them. 5. Keep everyone updated on the situation: community, family, and school.
Postvention 1 & 2 weeks after 1. Check-in with those who were on the checklist ask how they are currently feeling. Let them know they can stop by to talk whenever they want. 2. Review the crisis plan and make adjustments based on what transpired during the past event. 3. Check-in with the family to see if there is anything else that the school/community can be of assistance. 4. Meet with administrators to identify upstream approaches for the upcoming year (or two) that will stem the flow of students who become at-risk for suicide.
II. Goals for Suicide Postvention Procedures Postvention Procedures Use a calling tree Faculty & staff meeting before school Counselor should follow S s schedule and attend his/her classes Counselor or School Psychologist make contact w/parents and offer assistance
II. Goals for Suicide Postvention Procedures Postvention Procedures (cont) Acknowledge the death honestly Discussions should occur in small groups Spokesperson designated to meet with media Keep principal/superintendent informed and updated
III. Specific DO s and DON Ts for Suicide Postvention DO s Do reach out to Parents and provide support for them Funeral should not compete with school Do provide a flexible school schedule
III. Specific DO s and DON Ts for Suicide Postvention DO s (cont 2) Do answer students questions honestly Do explain that suicide is often a result of mental health issues Do stress that suicide is preventable and everyone can help
III. Specific DO s and DON Ts for Suicide Postvention DO s (cont 3) Do provide resources for students who are feeling at risk for suicide provide crisis hotline numbers Teen line - 866 TEENLINK National Hotline - 800 273-TALK Do stress the positive strategies going on at the school
III. Specific DO s and DON Ts for Suicide Postvention DO s (cont 4) Do make sure all students hear the news at the same time Do identify others who could be at additional risk Friends, siblings, and past students who have attempted suicide
III. Specific DO s and DON Ts for Suicide Postvention DO s (cont 5) Do send a letter home to all parents regarding the situation. Include What the school is doing/offering Community resource numbers Warning signs for suicidal behavior Example of how parents can talk to their teens about suicide
III. Specific DO s and DON Ts for Suicide Postvention DO s (cont 6) Do remember anniversary dates Identify those that may be affected by the anniversary date Close friends/relationship partners Siblings, even if they attend a different school
III. Specific DO s and DON Ts for Suicide Postvention DO s (cont 7) Do return the school back to its regular schedule as soon as possible Students need the consistent and predictable structure school offers Helps students regulate their emotions
III. Specific DO s and DON Ts for Suicide Postvention DON Ts Do not hold an all school assembly Do not announce news over the PA system Do not plan any memorials beyond what is done for typical student deaths Do not deny access of information
III. Specific DO s and DON Ts for Suicide Postvention DON Ts (cont 2) Do not punish students for taking extra time to deal with the crisis Do not judge S s past behavior Do not report the suicide as unexplainable or blame anyone
III. Specific DO s and DON Ts for Suicide Postvention DON Ts (cont 3) Do not try to answer the? why question because you do not know Do not print pictures of the deceased Do not print story on front page and avoid details of methods
IV. American Association of Suicidology Guidelines for dealing with the Media Avoid details of the method Do not report the suicide as unexplainable Avoid making the story front-page news Do not print a photograph of the deceased
IV. American Association of Suicidology Guidelines for dealing with the Media (cont) Refrain from coverage that excites or sensationalizes Do not imply approval of suicide Avoid discussing the specific details of the situation Include positive outcomes of the suicidal crisis Include information about warning signs, sources of help, and what to do if someone is suicidal
National Resource and Information Numbers American Association of Suicidology www.suicidology.org 202 237-2280 National Suicide Prevention Lifeline 800 273-TALK
National Resource and Information Numbers Miller, D.N. (2011). Child and Adolescent Suicidal Behavior: School- Based Prevention, Assessment, and Intervention. New York, NY: Guilford. After a Suicide: A Toolkit for Schools: www.sprc.org/sites/sprc.org/files/library/ AfteraSuicideToolkitforSchools.pdf
Do not reproduce or distribute without written permission from James J. Mazza Mazza Consulting, 2018
Business Card James J. Mazza, Ph.D. Miller Hall, Box 353600 University of Washington Seattle, WA 98195-3600 (206) 616-6373 mazza@uw.edu Do not reproduce or distribute without written permission from James J. Mazza Mazza Consulting, 2016