H.E.L.P. Facilitator s Guide
H.E.L.P. Suicide Prevention Curriculum for High School Developed by: Susan Eastgard, MSW Lisa Watson, MPH Edited 2017 by: Allie Franklin, MSW, LICSW Executive Director Crisis Clinic Jennifer Winslow, M. Ed., LMHC Training Manager Crisis Clinic Crisis Clinic 9725 3rd Ave NE, Suite 300 Seattle, Washington 98115 www.crisisclinic.org 2017 by Crisis Clinic All rights reserved. Printed in the United States of America. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. Failure to comply with these terms may expose you to legal action and damages for copyright infringement.
H.E.L.P. Table of Contents Lesson 1: Handouts 1 Lesson 2: Handouts 6 Lesson 3: Handouts 10 Lesson 4: Handouts 17 Table of Contents
H.E.L.P. Lesson One Handouts 1 Lesson One: Stress and Depression
H.E.L.P. Lesson One: Stress and Depression Possible Impact of Depression When someone is depressed, what are a few possible negative effects on that person or others? What are the benefits of getting help for depression? Work in small groups to complete both sides of this worksheet. School or Work Effects (i.e. missing class ) 1. 2. 3. Physical Effects (i.e. losing weight ) 1. 2. 3. Emotional or Personal Effects (i.e. friends are annoyed with me always being down ) 1. 2. 3. 2 Lesson One: Stress and Depression
Lesson One: Stress and Depression Benefits of Getting Help H.E.L.P. What are the benefits of getting help for depression? 1. 2. 3. What can a depressed person do to help themself? 1. 2. 3. What can friends do to help someone who is depressed? 1. 2. 3. What can professionals do to help someone who is depressed? 1. 2. 3. 3 Lesson One: Stress and Depression
Answer Sheet Lesson One: Stress and Depression Possible Impact of Depression H.E.L.P. School or Work Effects (i.e. missing class ) 1. not coming to school or being tardy 2. not bothering to do homework or study for exams 3. giving up on going to college Physical Effects (i.e. losing weight ) 1. sleeping a lot or hardly at all 2. not caring about my appearance 3. self-imjury Emotional or Personal Effects (i.e. friends are annoyed with me always being down ) 1. withdraw and avoid seeing friends 2. get angry and start arguments 3. believe that friends don t really care 4 Lesson One: Stress and Depression
Answer Sheet Lesson One: Stress and Depression Benefits of Getting Help H.E.L.P. What are the benefits of getting help for depression? 1. can begin to feel better 2. understand that you are not a freak or crazy 3. get perspective and an opportunity to think about the future What can a depressed person do to help themself? 1. talk to friends; tell someone how you feel 2. exercise; get good-night s sleep; eat healthy foods 3. write in journal; play music What can friends do to help someone who is depressed? 1. listen 2. do things together; be supportive 3. try to understand; avoid shame or ridicule What can professionals do to help someone who is depressed? 1. listen, offer suggestions, be supportive 2. teach skills to cope better 3. decide if medicine is appropriate 5 Lesson One: Stress and Depression
H.E.L.P. Lesson Two Handouts 6 Lesson Two: Warning Signs/Causes of Suicidal Behaviors
H.E.L.P. Facts and Myths: Suicide Questionnaire Circle True (T) or False (F) 1. T F 2. T F 3. T F 4. T F 5. T F 6. T F 7. T F 8. T F 9. T F If my friend talked about killing themself, even jokingly, they could really mean it and might die by suicide. Once a teen attempts suicide, they have a higher risk for attempting again. Teens who use drugs or alcohol are not at a greater risk for dying by suicide. If you ask a friend if they are suicidal, you will be planting the idea in their head. Reckless driving or doing dangerous things that could lead to death may be a sign that a teen is having thoughts of suicide or is unclear whether they want to live. Suicide is the second most common cause of death among adolescents and young adults in the U.S. Over 30% of LGBTQI+ youth attempt suicide. There are no warning signs before a suicide takes place. Once a person is suicidal, they are suicidal forever. 7 Lesson Two: Warning Signs/Causes of Suicidal Behaviors
Answer Sheet Facts and Myths: Suicide Questionnaire Circle True (T) or False (F) H.E.L.P. 1. T F TRUE 2. T F TRUE 3. T F FALSE 4. T F FALSE 5. T F TRUE If my friend talked about killing themself, even jokingly, they could really mean it and might die by suicide. 80% of those individuals who die by suicide have left definite warning signs, including talk about suicide. Often, those who talk about suicide do attempt suicide. Once a teen attempts suicide, they have a higher risk for attempting again. A suicide attempt is considered a cry for help. A majority of those who complete suicide have made a previous attempt and that is why it is extremely important to get professional help right away. Teens who use drugs or alcohol are not at a greater risk for dying by suicide. Using drugs and/or alcohol makes problems worse and can lead to suicidal feelings. Sadly, substance abusers are often isolated from their friends and/or family members, so they are unable to notice this warning sign. If you ask a troubled friend if they are suicidal, you will be planting the idea in their head. Talking about suicide with teens who are suicidal will not give them the idea or lead them to attempt suicide. On the contrary, it shows you care and are interested in their wellbeing. It can actually help them to open up and talk about problems they re facing. Reckless driving or doing dangerous things that could lead to death may be a sign that a teen is having thoughts of suicide or is unclear whether they want to live. Teens who are attracted to high-risk behaviors may be suicidal and/or have ambivalent feelings about living. Most teens who attempt suicide do not want to die; they want their problems (pain) to go away. 8 Lesson Two: Warning Signs/Causes of Suicidal Behaviors
Answer Sheet Facts and Myths: Suicide Questionnaire Circle True (T) or False (F) H.E.L.P. 6. T F TRUE 7. T F TRUE 8. T F FALSE 9. T F FALSE Suicide is the second most common cause of death among adolescents and young adults in the U.S. Unfortunately, deaths from suicide for youth ages 10-24 are on the rise that s why learning about suicide prevention is so important. Unintentional injuries are the leading cause of death for teens, including motor vehicle collisions, falls, and other types of accidents. Some of these might actually be suicides in disguise because a person might purposefully put themself in dangerous situations and take unnecessary risks. Over 30% of LGBTQI+ youth attempt suicide. Numerous studies indicate that LGBTQI+ youth are at a higher risk of making a suicide attempt than non-lgbtqi+ youth. There are no warning signs before a suicide takes place. Most individuals who die by suicide leave clues either verbally or through their behavior. You will learn more about these warning signs during this lesson. Once a person is suicidal, they are suicidal forever. People can be helped with the aid of professional counselors. When helped, the vast majority of suicidal persons do not die by suicide. Instead they learn other less destructive solutions to their problems. 9 Lesson Two: Warning Signs/Causes of Suicidal Behaviors
H.E.L.P. Lesson Three Handouts 10 Lesson Three: Suicide Intervention Skills
H.E.L.P. Prevention Steps 1. Show You Care. Listen carefully. I am concerned about you and about how you re feeling. You mean a lot to me, and I want to help. I don t want you to kill yourself. 2. Ask the Question. Be direct in a caring, nonconfrontational way. Are you thinking about suicide? How long have you been thinking about suicide? Have you thought about how you would do it? 3. Get Help. Do not leavethem alone. You are not alone. Let me help you. Let s call the crisis line. I can go with you to where we can get some help. You re not alone. Let me help you. Resources for Help School Counselor Crisis Hotline Physicians / Health Care Providers Mental Health Specialist Hospital ER Staff Warning Signs 1. Suicide-Risk Behaviors Past attempts Talking about suicide, making plans Preoccupation with death 2. Depression Moody, down Feeling hopeless, withdrawing 3. Drug Use Moody, sad, down in the dumps Feeling hopeless, withdrawing Things That Increase Risk Easy access to guns Impulsiveness No one to talk to 11 Lesson Three: Suicide Intervention Skills
SHOW YOU CARE SHOW YOU CARE
ASK THE QUESTION ASK THE QUESTION
GET HELP GET HELP
H.E.L.P. What is Helpful? 1. Show You Care I am concerned about you and about how you re feeling. 2. Ask the Question Are you thinking about suicide? 3. Get Help You are not alone. Let me help you. Let s call the crisis line. 15 Lesson Three: Suicide Intervention Skills
Answer Sheet What is Helpful? 1. Show You Care H.E.L.P. I am concerned about you and about how you re feeling. I really want to help you. I ll be here anytime you want to talk. You look bummed. Wanna talk? 2. Ask the Question Are you thinking about suicide? Are you thinking about killing yourself? Do you feel that life is so bad that you want to end your life? Do feel like dying? 3. Get Help You are not alone. Let me help you. Let s call the crisis line. You know I ll always be here for you, but I believe the both of us should go talk to the counselor. Is there anything that I can do to help? Who would you like to talk with? Lots of people love you and wouldn t want to see you hurt. Let s get help together. 16 Lesson Three: Suicide Intervention Skills
H.E.L.P. Lesson Four Handouts 17 Lesson Four: Suicide Intervention Skills Practice
H.E.L.P. Obstacles that get in the way of helping Solutions 1. 2. 3. 4. 18 Lesson Four: Suicide Intervention Skills Practice
Answer Sheet H.E.L.P. Obstacles that get in the way of helping Solutions 1. What if I make the situation worse? What if I say the wrong thing? Believe in my ability to help. Interaction doesn t have to get overly personal. Important things are to show that I care and that help is available. Important to practice helpful steps. 2. What if my friend is just being dramatic? Better to take the suicidal threats seriously, because it s the right thing to do. 3. I am afraid of retribution (backlash) by my friend s parents or others. In the long run, what alternative do I really have? My friend could die and that would be the worst possible outcome. 4. What if I really don t have a way of getting the person help, like I don t have a car? Use the telephone to make a call or speak with an adult. 19 Lesson Four: Suicide Intervention Skills Practice
Teacher Guide for Facilitated Role-Plays Scripted lines for teacher to read are underlined and bolded. Possible student answers in quotes. H.E.L.P. Role-play #1: Nathan (age 14) is depressed and has been seeing a psychologist for about six months. He recently got caught smoking pot, and because of that, was suspended from his soccer team. He hasn t come to school for a couple of days and you wonder what is going on. How do you show him that you care? Hey, I haven t seen you at school for a couple of days and I was worried about you. Are you okay? What s going on? I m worried about you. I heard that you got suspended from the soccer team. That must be awful. Now imagine that he tells you life just isn t worth living, and that everything is messed up. How would you ask him directly about suicide? You just said that everything is messed up and life isn t worth living. Does that mean you are thinking about giving up, about dying? Are you telling me that you are thinking about suicide? Sounds pretty bad. Is it so bad that you want to end it all? In response Nathan says, Yeah, it would just be easier. What might be the obstacles for getting help for Nathan? Nathan doesn t want anyone to know he is depressed and suicidal. Nathan is afraid to talk with his counselor; he hasn t been helpful. Nathan is certain that his parents will be even more disappointed in him. What could you say to overcome those obstacles and get him help? We need to talk with some adult. Who would you trust? I would go with you to talk with someone. I don t know your parents very well, but I am sure they would be very sad if you actually ended your life. They probably don t understand how badly you feel. If you won t go with me to talk, then I need to go myself. I am really worried about you. 20 Lesson Four: Suicide Intervention Skills Practice
Teacher Guide for Facilitated Role-Plays H.E.L.P. Role-play #2: Ashley (age 15) has been sad and moody for over a month. She has declined your invitations to hang out. Instead she seems to be spending a lot of time writing poetry and thinking about being invisible. She has just sent you a text message telling you about an argument she had with her mother over a failing grade. How do you show her that you care? I m concerned that you think your life is really messed up right now. You ve been sad for awhile and now you have just had this fight with your mom. That must be really horrible. Do you want to talk about the stuff that is going wrong in your life? I would be glad to listen. In response to your concern, Ashley tells you, Thanks, but I can t see how my life is going to get any better. How would you ask directly about suicide? You sound really discouraged. Are so down that you are thinking about ending it all? You sound really sad and hopeless. People who are suicidal sometimes can t see another way out. Are you feeling that way? Are you thinking of killing yourself? I would like to make things all better, but I can t. What I can do is listen and help but first I need to know how desperate you are. Are you thinking about suicide? In response Ashley answers, Yes, but why do you care? What might be the obstacles for getting help for Ashley? Ashley is ashamed of feeling this way. Ashley is worried that you will stop being her friend. Ashley doesn t believe that anyone can really help her feel better. How might you overcome those obstacles and get her help? I want to help you. You are my friend and I care about you. Let s go talk with the school counselor. I won t stop being your friend. I care too much about you to stop caring. If we go to talk with the counselor, I can stay with you if you want. 21 Lesson Four: Suicide Intervention Skills Practice
Teacher Guide for Facilitated Role-Plays H.E.L.P. Role-play #3: Lee (age 12) seems to get angry over nothing. He hates school and doesn t bother to turn in his homework. His older sister has recently been diagnosed with cancer and his parents spend all their time at doctor s appointments or medical procedures. He isn t interested in talking and would rather just play video games. How do you show him that you care? What s going on? You seem like you are mad all the time. I heard about your sister. That s really sad. It doesn t seem like you want to talk, so let s just play video games together. In response to your concern, he gets angry and tells you, You won t have to worry about me much longer. How would you ask directly about suicide? I am not sure what that means exactly, but I am concerned that you are talking about killing yourself. Is that what you are saying? You are worrying me. Are you thinking about suicide? I can t stop worrying about you. I am your friend. When you say that I don t have to worry about you much longer, I think you are planning to check out to die. Is that what you are saying? In response, Lee says Yes, but I don t want you to stop me and don t tell anyone else. What could you do to help? I need to tell someone if you won t. I would like you to talk to a counselor or some other adult that you trust. Is there anyone you could talk to? I can t keep this a secret. You may be mad at me, but I just can t do nothing. 22 Lesson Four: Suicide Intervention Skills Practice
Teacher Guide for Facilitated Role-Plays H.E.L.P. Role-play #4: Heather (age 15) is very thin and is always worrying about being overweight. She is your really good friend and she has told you there are times when she gets so anxious she can t sit still or think clearly. She gets really good grades, but her mother thinks that she could do even better. She has just had a fight with her boyfriend and is crying in the bathroom at school. How do you show her that you care about her? I am really concerned about you. It seems like you are not doing well. Let s talk. I am not sure exactly how to help, but I will try. Imagine she responds by saying, Thanks for being my friend. You understand me, but no one else does. What more would you need to ask about to find out if she is suicidal? How long having you being feeling this way? Have you thought about how you might resolve these problems? Imagine that you asked her whether she was so sad that she was thinking about suicide and she said, No. She may not be suicidal, but you are still worried about Heather. Where can she go for help for her anxiety? We need to go talk to someone. Who would you suggest? I know you said you were not suicidal, but you are dealing with lots of problems. It sounds like some help is needed. You probably don t want to talk with your boyfriend or mother right now, but I think we should talk with someone. I know about a crisis line. Do you want to try calling there? 23 Lesson Four: Suicide Intervention Skills Practice
Teacher Guide for Facilitated Role-Plays H.E.L.P. Role-play #5: Natasha (age 16) has just been dumped by her boyfriend. You know she takes medicine for bipolar disorder, but you don t think she sees a counselor. At lunch, you notice that she has new scratch marks on her wrists. She has cut herself before when she was frustrated or upset. How do you show her that you care? I am concerned about the scratches on your arm. Do you want to talk? Things aren t going very well for you, are they? I am here to listen. I heard that Peter broke up with you. How are you doing? How could you ask her directly about suicide? Sometimes when people hurt themselves they are thinking about suicide. Are you? With so many things going wrong, I am concerned that you are thinking about killing yourself. Are you? I wonder if you are feeling like dying and just escaping from all your problems. In response, she answers that she isn t sure. What would you say to get her help? I want you to get some help. I don t know for sure what to do. Who would you feel okay talking with? I would be willing to go with you. Who should we talk with? 24 Lesson Four: Suicide Intervention Skills Practice
Teacher Guide for Facilitated Role-Plays H.E.L.P. Role-play #6: Jeremy (age 18) tells you, while he is driving you home, that he found out today that he is failing chemistry and he will not have enough credits to graduate from high school. He suggests that the two of you get drunk and just forget about life. You have never seen him this upset. You heard a rumor today about Jeremy that he is gay but you don t really know if he is or whether that really matters. How do you show him that you care? You really are upset. I wish I could make things better. Should we just talk a little? I am not sure what all is going on, but it seems like there is a lot. I m sorry. How do you handle the suggestion of getting drunk? I am not so sure that drinking will make things better. How about we go somewhere and talk? What, if anything, do you say to Jeremy about the rumor you heard related to his sexual orientation? Say nothing and do not spread the rumor. I heard a rumor in school, and I want you to know that if it is true, it makes no difference to me. How do you follow up on comment about forgetting life? Does he mean suicide? How would you find out? Are you talking about suicide? When you say that you want to forget about life, do you mean temporarily or permanently? How would you help Jeremy? I think we should talk with someone. Who can we talk to? This is serious. 25 Lesson Four: Suicide Intervention Skills Practice
H.E.L.P. 26 Notes
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