College Students and Suicide Prevention – Faculty and Staff Ellen J. Anderson, Ph.D., SPCC Person...

College Students College Students and Suicide and Suicide PreventionPrevention – –

Faculty and StaffFaculty and Staff

Ellen J. Anderson, Ph.D., SPCCEllen J. Anderson, Ph.D., SPCCPerson To Person ResourcesPerson To Person Resources

[email protected]@verizon.netMay 27, 2009May 27, 2009

College Suicide Prevention - Ellen AndersCollege Suicide Prevention - Ellen Anderson, Ph.D., SPCCon, Ph.D., SPCC

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College Student SuicideCollege Student Suicide

Suicide is the second leading cause Suicide is the second leading cause of death for college studentsof death for college students

The number one cause of suicide for The number one cause of suicide for college student suicides (and all college student suicides (and all suicides) is untreated depressionsuicides) is untreated depression


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Despair At A Young AgeDespair At A Young Age

““Unlike most disabling physical diseases, Unlike most disabling physical diseases, mental illness begins very early in life. Half of mental illness begins very early in life. Half of all lifetime cases begin by age 14; three all lifetime cases begin by age 14; three quarters have begun by age 24. Thus, mental quarters have begun by age 24. Thus, mental disorders are really the chronic diseases of the disorders are really the chronic diseases of the young,young,” ” (National Institute of Mental Health)(National Institute of Mental Health)

Anxiety disorders often begin in late childhoodAnxiety disorders often begin in late childhood Mood disorders in late adolescenceMood disorders in late adolescence Substance abuse in the early 20’sSubstance abuse in the early 20’s Unlike heart disease or most cancers, young Unlike heart disease or most cancers, young

people with mental disorders suffer disability people with mental disorders suffer disability when they are in the prime of life, when they when they are in the prime of life, when they would normally be the most productivewould normally be the most productive


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Many young people who come to college Many young people who come to college have not yet been diagnosed with have not yet been diagnosed with Depression, Schizophrenia, or Bi-Polar Depression, Schizophrenia, or Bi-Polar DisorderDisorder

We are seeing an increase in suicidal We are seeing an increase in suicidal ideation and behavior on campus as more ideation and behavior on campus as more people with severe mental illness attend people with severe mental illness attend collegecollege

Improved treatment has allowed many Improved treatment has allowed many young people to continue a normal life young people to continue a normal life despite the development of severe mental despite the development of severe mental illnessesillnesses


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In general, non-college young adults In general, non-college young adults complete suicide at about twice the rate complete suicide at about twice the rate as college studentsas college students

Foreign students may have a higher risk Foreign students may have a higher risk for suicidefor suicide

Suicide is not more frequent in any of Suicide is not more frequent in any of the four years of college, but it does the four years of college, but it does occur more often in students who take occur more often in students who take more than four years to earn their more than four years to earn their degreesdegrees


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High Levels Of StressHigh Levels Of Stress

Going to college can be a difficult transition Going to college can be a difficult transition period in which students may experience high period in which students may experience high levels of stress, which can lead to Clinical levels of stress, which can lead to Clinical DepressionDepression

Many college students also use higher levels Many college students also use higher levels of alcohol and drugs than at earlier times in of alcohol and drugs than at earlier times in their lives, increasing the risk of suicidal their lives, increasing the risk of suicidal ideationideation

A hallmark of diagnosis for clinical depression A hallmark of diagnosis for clinical depression is the presence of suicidal thinkingis the presence of suicidal thinking

Yet our lack of knowledge about this illness Yet our lack of knowledge about this illness means that we don’t seek help, and our means that we don’t seek help, and our friends and family don’t push us to get helpfriends and family don’t push us to get help


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Unwilling To Seek HelpUnwilling To Seek Help

Stigma about treatment means that very few Stigma about treatment means that very few people with suicidal ideation actually seek people with suicidal ideation actually seek treatmenttreatment

Additionally, a survey indicates that one in five Additionally, a survey indicates that one in five college students believe that their depression college students believe that their depression level is higher than it should be, yet only 20% say level is higher than it should be, yet only 20% say they would go to the campus counseling centerthey would go to the campus counseling center

Those whose symptoms improve when they Those whose symptoms improve when they activate a suicide plan may be especially activate a suicide plan may be especially resistant to seeking help resistant to seeking help

Nearly half of suicidal students present for some Nearly half of suicidal students present for some medical treatment in the months before medical treatment in the months before completing suicide although they may not completing suicide although they may not acknowledge suicidal thoughtsacknowledge suicidal thoughts


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AwarenessAwareness

Faculty, coaches, advisors and residence hall Faculty, coaches, advisors and residence hall staff should focus not only on disruptive staff should focus not only on disruptive students, but also on those who are quietly students, but also on those who are quietly withdrawn or whose dormitory discussions or withdrawn or whose dormitory discussions or classroom essays disclose hopelessness and classroom essays disclose hopelessness and suicidal thinkingsuicidal thinking

Training in awareness about depression and Training in awareness about depression and suicidal thinking is important for everyone on suicidal thinking is important for everyone on campuscampus

Policies should be in place to discover students Policies should be in place to discover students with suicidal ideation and help them to recoverwith suicidal ideation and help them to recover


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How Common Is Suicide How Common Is Suicide Among Teenagers And Young Among Teenagers And Young

Adults?Adults? Suicide is the 3Suicide is the 3rdrd largest killer of young people between largest killer of young people between

the ages of 10 and 25, and the 2the ages of 10 and 25, and the 2ndnd largest killer of young largest killer of young adultsadults

Suicidal ideation is admitted by about 25% of adolescents Suicidal ideation is admitted by about 25% of adolescents at some time during high schoolat some time during high school

Suicide attempts are more frequent among the young Suicide attempts are more frequent among the young than the old, although completions are less likelythan the old, although completions are less likely

About 4,000 young people die from suicide every year in About 4,000 young people die from suicide every year in the USthe US

Teen suicide tripled between 1950 and 1990, but had Teen suicide tripled between 1950 and 1990, but had dropped somewhat until 2003dropped somewhat until 2003

Around the world, adolescent suicide declined in Around the world, adolescent suicide declined in industrialized nations with the increase in use of anti-industrialized nations with the increase in use of anti-depressant medication, despite fears that meds will depressant medication, despite fears that meds will increase suicidal behavior in teensincrease suicidal behavior in teens


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How Serious Is The Problem How Serious Is The Problem On Campus?On Campus?

Nearly half of all students at some point find Nearly half of all students at some point find themselves feeling so depressed they have trouble themselves feeling so depressed they have trouble functioningfunctioning

15 % meet the criteria for clinical depression, 15 % meet the criteria for clinical depression, according to a 2004 survey by the American College according to a 2004 survey by the American College Health AssociationHealth Association

Among students seen at campus counseling centers, Among students seen at campus counseling centers, the number taking psychiatric medications rose to the number taking psychiatric medications rose to 24.5 percent in 2003-200424.5 percent in 2003-2004• 17 % in 200017 % in 2000• 9 % in 1994, according to the National Survey of 9 % in 1994, according to the National Survey of

Counseling Center DirectorsCounseling Center Directors(Duenwald, 2004, NYTimes)(Duenwald, 2004, NYTimes)


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11Gatekeeper Training- Dr. Ellen

Anderson

What Is Mental Illness?What Is Mental Illness?

Prior to our understanding of illness Prior to our understanding of illness caused by bacteria, most people thought caused by bacteria, most people thought of any illness as a spiritual failure or of any illness as a spiritual failure or demon possessiondemon possession

Contamination meant spiritual Contamination meant spiritual contaminationcontamination

People were frightened to be near People were frightened to be near someone with odd behavior for fear of someone with odd behavior for fear of being contaminated-spiritually damagedbeing contaminated-spiritually damaged


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What do we say about someone who is What do we say about someone who is odd?odd?• Looney, batty, nuts, crazy, wacko, lunatic, Looney, batty, nuts, crazy, wacko, lunatic,

insane, fruitcake, psycho, not all there, bats insane, fruitcake, psycho, not all there, bats in the belfry, gonzo, bonkers, wackadoo, in the belfry, gonzo, bonkers, wackadoo, crazycrazy

Why would anyone admit to having a Why would anyone admit to having a mental illness?mental illness?

So much stigma makes it very difficult So much stigma makes it very difficult for people to seek help or even for people to seek help or even acknowledge a problemacknowledge a problem


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Anderson


We know that illnesses like epilepsy, We know that illnesses like epilepsy, Parkinson's and Alzheimer’s are physical Parkinson's and Alzheimer’s are physical illness in the brainillness in the brain

Somehow, clinical depression, anxiety, Somehow, clinical depression, anxiety, Bi-Polar Disorder and Schizophrenia are Bi-Polar Disorder and Schizophrenia are not considered physical illnesses not considered physical illnesses requiring treatmentrequiring treatment

We confuse brain with mindWe confuse brain with mind Talking about suicide is taboo- which Talking about suicide is taboo- which

means no research, no grants, no place means no research, no grants, no place for discussion on campusfor discussion on campus


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Anderson

8787 people complete suicide every day people complete suicide every day 32,46632,466 people in 2005 in the US people in 2005 in the US Over Over 1,000,0001,000,000 suicides worldwide suicides worldwide

(reported)(reported) This data refers to completed This data refers to completed

suicides that are documented by suicides that are documented by medical examiners – it is estimated medical examiners – it is estimated that 2-3 times as many actually that 2-3 times as many actually complete suicide complete suicide (Surgeon General’s (Surgeon General’s Report on Suicide, 1999)Report on Suicide, 1999)

Is Suicide Really a Is Suicide Really a Problem?Problem?


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Anderson

The Gender IssueThe Gender Issue Women perceived as being at higher risk than menWomen perceived as being at higher risk than men Women do make attempts 4 x as often as menWomen do make attempts 4 x as often as men But - Men complete suicide 4 x as often as womenBut - Men complete suicide 4 x as often as women Women’s risk rises until midlife, then decreasesWomen’s risk rises until midlife, then decreases Men’s risk, always higher than women’s, continues Men’s risk, always higher than women’s, continues

to rise until end of lifeto rise until end of life Are women more likely to seek help? Talk about Are women more likely to seek help? Talk about

feelings? Have a safety network of friends?feelings? Have a safety network of friends? Do men suffer from depression silently? Do men suffer from depression silently?


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16Gatekeeper Training- Dr. Ellen Anderson

What Factors Put What Factors Put Someone At Risk For Someone At Risk For

Suicide?Suicide? Biological, physical, social, psychological or Biological, physical, social, psychological or

spiritual factors may increase risk-for example:spiritual factors may increase risk-for example: A family history of suicide increases risk by 6 A family history of suicide increases risk by 6

timestimes Access to firearms – people who use firearms Access to firearms – people who use firearms

in their suicide attempt are more likely to diein their suicide attempt are more likely to die Social Isolation: people may be rejected or Social Isolation: people may be rejected or

bullied because they are “weird”, because of bullied because they are “weird”, because of sexual orientation, or because they are getting sexual orientation, or because they are getting older and have lost their social networkolder and have lost their social network

(Goleman, 1997)(Goleman, 1997)


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Anderson

A significant loss by death, separation, A significant loss by death, separation, divorce, moving, or breaking up with a divorce, moving, or breaking up with a boyfriend or girlfriend can be a triggerboyfriend or girlfriend can be a trigger

The 2nd biggest risk factor - having an The 2nd biggest risk factor - having an alcohol or drug problemalcohol or drug problem• Many with alcohol and drug problems are Many with alcohol and drug problems are

clinically depressed, and are self-clinically depressed, and are self-medicating for their painmedicating for their pain

(Surgeon General’s call to Action, 1999)(Surgeon General’s call to Action, 1999)


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Anderson

The biggest risk factor for suicide The biggest risk factor for suicide completion? completion?

Having a Depressive IllnessHaving a Depressive Illness Clinically depressed people often feel helpless Clinically depressed people often feel helpless

to solve problems, leads to hopelessness – a to solve problems, leads to hopelessness – a strong predictor of suicide riskstrong predictor of suicide risk

At some point in this chronic illness, suicide At some point in this chronic illness, suicide seems like the only way out of the pain and seems like the only way out of the pain and sufferingsuffering

Many Mental health diagnoses have a Many Mental health diagnoses have a component of depression: anxiety, PTSD, Bi-component of depression: anxiety, PTSD, Bi-Polar, etcPolar, etc

90%90% of suicide completers have a of suicide completers have a depressive illness depressive illness

(Lester, 1998, Surgeon General, 1999)(Lester, 1998, Surgeon General, 1999)


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Depression Is An Depression Is An IllnessIllness Our cultural view of suicide is wrong - invalidated Our cultural view of suicide is wrong - invalidated

by current understanding of brain chemistry and by current understanding of brain chemistry and it’s interaction with stress, trauma and genetics it’s interaction with stress, trauma and genetics on mood and behavioron mood and behavior

Suicidal thinking is a severe symptom of the way Suicidal thinking is a severe symptom of the way depression is altering the brain – causing changes depression is altering the brain – causing changes in thinking, mood and body regulationin thinking, mood and body regulation

Suicide has been viewed for centuries as:Suicide has been viewed for centuries as:• a moral failing, a spiritual weakness, a mortal sina moral failing, a spiritual weakness, a mortal sin• an inability to cope with lifean inability to cope with life• ““the coward’s way out”the coward’s way out”• A character flawA character flaw

This view must be replaced by more current This view must be replaced by more current understanding of brain disorders as treatable, understanding of brain disorders as treatable, physical illnessesphysical illnesses


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The research evidence is overwhelming - depression is far The research evidence is overwhelming - depression is far more than a sad mood. It includes:more than a sad mood. It includes:

Body Regulation ProblemsBody Regulation Problems1.1. Weight gain/lossWeight gain/loss2.2. Sleep problemsSleep problems3.3. Sense of tiredness, exhaustionSense of tiredness, exhaustion

Mood Regulation ProblemsMood Regulation Problems1.1. Sad or angry moodSad or angry mood 2.2. Loss of interest in pleasurable things, lack of Loss of interest in pleasurable things, lack of

motivationmotivation3.3. IrritabilityIrritability

Thinking and Memory ProblemsThinking and Memory Problems1.1. Confusion, poor concentration, poor memory, Confusion, poor concentration, poor memory,

trouble making decisionstrouble making decisions2.2. Negative thinkingNegative thinking3.3. Withdrawal from friends and familyWithdrawal from friends and family4.4. Often, suicidal thoughtsOften, suicidal thoughts

(DSMIVR, 2002)(DSMIVR, 2002)


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AndersonAnderson

20 years of brain research 20 years of brain research teaches that these symptoms are teaches that these symptoms are the the behavioralbehavioral result of result of Changes in the physical Changes in the physical structure of the brainstructure of the brain

Damage to brain cells in the Damage to brain cells in the hippocampus, amygdala and hippocampus, amygdala and limbic systemlimbic system

Depressed people suffer from a Depressed people suffer from a physical illness – what we might physical illness – what we might consider “faulty wiring”consider “faulty wiring”

(Braun, 2000; Surgeon General’s Call To (Braun, 2000; Surgeon General’s Call To Action, 1999,Action, 1999, Stoff & Mann, 1997, The Neurobiology of Suicide)Stoff & Mann, 1997, The Neurobiology of Suicide)


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Faulty Wiring?Faulty Wiring? Literally, damage to certain nerve cells in our Literally, damage to certain nerve cells in our

brains - the result of too many stress hormonesbrains - the result of too many stress hormones• CortisolCortisol• AdrenalineAdrenaline• Testosterone – hormones activated by our Testosterone – hormones activated by our AAutonomic utonomic

NNervous ervous SSystem to protect us in times of dangerystem to protect us in times of danger Chronic stress causes changes in the ANS, so Chronic stress causes changes in the ANS, so

that “fight or flight” is set off with little that “fight or flight” is set off with little stimulusstimulus

Constant stress hormone production without a way Constant stress hormone production without a way to relax causes physical changes in the brain and to relax causes physical changes in the brain and bodybody

(Goleman, 1997, Braun, 1999)(Goleman, 1997, Braun, 1999)


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Faulty Wiring?Faulty Wiring? Constant ANS activation causes changes in Constant ANS activation causes changes in

muscle tension, imbalances in blood flow muscle tension, imbalances in blood flow patterns - leads to asthma, IBS and depression, patterns - leads to asthma, IBS and depression, increased risk for death from heart diseaseincreased risk for death from heart disease

People with People with genetic predispositionsgenetic predispositions, placed in , placed in a highly a highly stressful environmentstressful environment will experience will experience damage to brain cells from stress hormonesdamage to brain cells from stress hormones

This leads to the cluster of This leads to the cluster of thinking and thinking and emotional changesemotional changes we call depression we call depression

Stress alone is not the problem, but our Stress alone is not the problem, but our interpretation of the eventinterpretation of the event

(Goleman, 1997; Braun, 1999)(Goleman, 1997; Braun, 1999)


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2424Gatekeeper Training- Dr. Ellen Gatekeeper Training- Dr. Ellen

AndersonAnderson

One of Many NeuronsOne of Many Neurons•Neurons are the cells that make up the brain and their united, networked action is what causes us to think, feel, and act •Neurons must connect to one another (through dendrites and axons) •Stress hormones damage dendrites and axons, causing them to “shrink” away from other connectors•As fewer and fewer connections are made, more and more symptoms of depression appear


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How Can We Stop Brain How Can We Stop Brain Damage?Damage?

As damage occurs, thinking changes in As damage occurs, thinking changes in the predictable ways identified in our the predictable ways identified in our list of 10 criterialist of 10 criteria

Four things can reduce this “brain Four things can reduce this “brain damage”damage”• Stress reducing mental exercises - Stress reducing mental exercises -

meditationmeditation• ExerciseExercise• Antidepressant medicationAntidepressant medication• Cognitive/Behavioral PsychotherapyCognitive/Behavioral Psychotherapy


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Many cultures have developed stress reduction Many cultures have developed stress reduction rituals/mental exercises – Yoga, Tai Chi, Qi Jong, rituals/mental exercises – Yoga, Tai Chi, Qi Jong, meditation, prayer – these millennia old methods meditation, prayer – these millennia old methods work well to reduce stress hormone productionwork well to reduce stress hormone production

Exercise can help “burn off” high stress hormone Exercise can help “burn off” high stress hormone levels and even reduce productionlevels and even reduce production

Antidepressants can counter the effects of stress Antidepressants can counter the effects of stress hormoneshormones

We know now that antidepressants stimulate genes We know now that antidepressants stimulate genes within the neurons (turn on growth genes) which within the neurons (turn on growth genes) which encourage the growth of new dendritesencourage the growth of new dendrites

New dendrites reconnect neurons and symptoms are New dendrites reconnect neurons and symptoms are reducedreduced

It can take longer than six weeks for the brain to It can take longer than six weeks for the brain to repair itself enough that people feel betterrepair itself enough that people feel better

(Braun, 1999)(Braun, 1999)


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How Does Therapy Help?How Does Therapy Help? Medications may relieve physical suffering and Medications may relieve physical suffering and

improve brain function, but do not change how improve brain function, but do not change how we we interpretinterpret stress stress

Cognitive or interpersonal psychotherapy Cognitive or interpersonal psychotherapy helps people change the (negative) patterns of helps people change the (negative) patterns of thinking that lead to depressed and suicidal thinking that lead to depressed and suicidal thoughtsthoughts

Changing our inaccurate beliefs and thought Changing our inaccurate beliefs and thought patterns alters our response to stress – we are patterns alters our response to stress – we are not as reactive or as affected by stress at the not as reactive or as affected by stress at the physical levelphysical level

Research shows that cognitive therapy is as Research shows that cognitive therapy is as effective as medication in reducing depression effective as medication in reducing depression and suicidal thinking and suicidal thinking

(Lester, 2004)(Lester, 2004)


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How Does Therapy Help?How Does Therapy Help?

““The Talking Cure” as Freud originally called it The Talking Cure” as Freud originally called it turns out to have a scientific basis for success turns out to have a scientific basis for success

Daniel Goleman, Daniel Siegal, Antonio D’Amasio Daniel Goleman, Daniel Siegal, Antonio D’Amasio and others are explaining how social interaction and others are explaining how social interaction with others literally alters our neuronal paths, with others literally alters our neuronal paths, allowing different ways of thinking to change the allowing different ways of thinking to change the chemical, electrical and thought pattern flow in chemical, electrical and thought pattern flow in our brainsour brains

We know that people raised in highly abusive We know that people raised in highly abusive homes have visibly different brains than people homes have visibly different brains than people from normal homes, as seen on MRI’s and CAT from normal homes, as seen on MRI’s and CAT scansscans

We also know that healing relationships, changed We also know that healing relationships, changed perspectives (reframing) and altered self-beliefs perspectives (reframing) and altered self-beliefs change how people react to stresschange how people react to stress


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Anderson

Possible Sources Possible Sources Of DepressionOf Depression

Genetic: a predisposition to this problem may be Genetic: a predisposition to this problem may be present, and depressive diseases run in familiespresent, and depressive diseases run in families

Predisposing factors: Childhood traumas, car Predisposing factors: Childhood traumas, car accidents, brain injuries, abuse and domestic accidents, brain injuries, abuse and domestic violence, poor parenting, growing up in an violence, poor parenting, growing up in an alcoholic home, chemotherapyalcoholic home, chemotherapy

Immediate triggers: violent attack, illness, Immediate triggers: violent attack, illness, sudden loss or grief, loss of a relationship, any sudden loss or grief, loss of a relationship, any severe shock to the systemsevere shock to the system

(Anderson, 1999, Berman & Jobes, 1994, Lester, 1998)(Anderson, 1999, Berman & Jobes, 1994, Lester, 1998)


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Anderson

What Happens If We Don’tWhat Happens If We Don’tTreat Depression?Treat Depression?

Significant risk of increased alcohol Significant risk of increased alcohol and drug useand drug use

Significant relationship problemsSignificant relationship problems Lost work days, lost productivity (up Lost work days, lost productivity (up

to $40 billion a year)to $40 billion a year) High risk for suicidal thoughts, High risk for suicidal thoughts,

attempts, and possibly deathattempts, and possibly death(Surgeon General’s Call To Action, 1999)(Surgeon General’s Call To Action, 1999)


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What Are "Best Practices" In What Are "Best Practices" In Staff Training And Educational Staff Training And Educational

ProgrammingProgramming

The United States Air Force modelThe United States Air Force model Develop a campus-wide commitment to Develop a campus-wide commitment to

suicide preventionsuicide prevention Reduce stigma against seeking Reduce stigma against seeking

professional helpprofessional help Depression screening programs and Depression screening programs and

online resources – Jed Foundation, online resources – Jed Foundation, American Foundation For Suicide American Foundation For Suicide PreventionPrevention


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What Are Administrative What Are Administrative Responsibilities?Responsibilities?

We should not be looking at student suicide We should not be looking at student suicide primarily from a risk-management perspectiveprimarily from a risk-management perspective

College administrator responses to students College administrator responses to students seem to become defined legally and not seem to become defined legally and not through primary responsibility as educatorsthrough primary responsibility as educators

“ “As educators, we have to take some risks. As educators, we have to take some risks. That means working harder to keep students That means working harder to keep students at risk of suicide enrolled, working with them, at risk of suicide enrolled, working with them, giving them the help they need, and not giving them the help they need, and not finding faster and more creative ways to finding faster and more creative ways to remove them. “ (Gary Pavela, 2006, The remove them. “ (Gary Pavela, 2006, The Chrone)Chrone)


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A Protective EnvironmentA Protective Environment Mandatory-removal policies carry legal risks of their Mandatory-removal policies carry legal risks of their

own - ADAown - ADA Office for Civil Rights within the U.S. Department of Office for Civil Rights within the U.S. Department of

Education has been called upon to issue letter rulings Education has been called upon to issue letter rulings pertaining to these policies – students with documented pertaining to these policies – students with documented mental health diagnoses may win a lawsuitmental health diagnoses may win a lawsuit

The risk of liability for suicides is low – most cases The risk of liability for suicides is low – most cases focus on high risk immediate suicidalityfocus on high risk immediate suicidality

College administrators, may err on the side of under-College administrators, may err on the side of under-reaction, in terms of notifying parents, in terms of reaction, in terms of notifying parents, in terms of hospitalizationhospitalization

Decisions in some recent cases do not define the law Decisions in some recent cases do not define the law nationally and do not mean your proper response as an nationally and do not mean your proper response as an administrator is to find a quick way to get rid of the administrator is to find a quick way to get rid of the studentstudent

Cases point to reacting promptly and appropriately to a Cases point to reacting promptly and appropriately to a student who is manifesting imminent risk of suicide student who is manifesting imminent risk of suicide (Pavela, 2006)(Pavela, 2006)


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Parental NotificationParental Notification

Should colleges notify parents of students at risk of Should colleges notify parents of students at risk of suicide?suicide?

Previously, a strong bias not to notify parents about student Previously, a strong bias not to notify parents about student problems problems

In recent years a shift toward more parental notificationIn recent years a shift toward more parental notification FERPA [Family Educational Rights and Privacy Act] amended; FERPA [Family Educational Rights and Privacy Act] amended;

able to notify parents in certain alcohol incidentsable to notify parents in certain alcohol incidents Who should notify parents and under what conditions?Who should notify parents and under what conditions? Mental-health professionals will have a legal and ethical Mental-health professionals will have a legal and ethical

obligation to breach confidentiality in an emergency, when a obligation to breach confidentiality in an emergency, when a person is at imminent risk of harming themselvesperson is at imminent risk of harming themselves

Parents would be notified by the hospital Parents would be notified by the hospital When students enroll, it should be part of their file: When students enroll, it should be part of their file: Who do Who do

you want notified in case of emergency?you want notified in case of emergency?


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Parental NotificationParental Notification Administrators have more latitude than mental-Administrators have more latitude than mental-

health professionals to notify parentshealth professionals to notify parents Err on the side of treating suicidal statements as Err on the side of treating suicidal statements as

a genuine suicide threat or gesture, a genuine suicide threat or gesture, Arrange for immediate evaluation of that student, Arrange for immediate evaluation of that student, Ask the student about needing to involve the Ask the student about needing to involve the

parents immediately,parents immediately, Listen to arguments about why that wouldn't Listen to arguments about why that wouldn't

work, and talk to a mental-health professional.work, and talk to a mental-health professional. Once there is a suicide threat or gesture - notify Once there is a suicide threat or gesture - notify

parents, even when it isn't a full-blown emergencyparents, even when it isn't a full-blown emergency


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Should Colleges Withdraw Should Colleges Withdraw Students Who Threaten Or Students Who Threaten Or

Attempt Suicide?Attempt Suicide? Rate of young-adult suicide for people going to college is about Rate of young-adult suicide for people going to college is about

one-half of the rate for young adults who are not going to collegeone-half of the rate for young adults who are not going to college Campus environments, human connection, and limited access to Campus environments, human connection, and limited access to

firearms are protective firearms are protective College campuses do a good job of limiting firearms, the most College campuses do a good job of limiting firearms, the most

dangerous choice of a suicide weapon dangerous choice of a suicide weapon Sending kids home means taking them out of a protective Sending kids home means taking them out of a protective

environment environment Use the administrative process as a lever to get the student help Use the administrative process as a lever to get the student help Policies can use the threat of removal as "leverage"Policies can use the threat of removal as "leverage" We are a community that can't tolerate violence, including We are a community that can't tolerate violence, including

violence to self, and we have a mechanism to help you, if not, we violence to self, and we have a mechanism to help you, if not, we can remove youcan remove you


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Jed Foundation Prevention Jed Foundation Prevention ModelModel


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Empowering Students To Empowering Students To Help Prevent Suicides Help Prevent Suicides

Among PeersAmong Peers Often peers know about potentially suicidal Often peers know about potentially suicidal

and depressed behavior and commentsand depressed behavior and comments Increase discussion with students about the Increase discussion with students about the

responsibility of friendship responsibility of friendship A higher loyalty is to save a person's life, not A higher loyalty is to save a person's life, not

keep a person’s secret keep a person’s secret Friends don't let depressed students handle Friends don't let depressed students handle

their problem alone, and they get help for their problem alone, and they get help for that student, even if they have to break that student, even if they have to break confidentialityconfidentiality

Teach when to get help and where to get it – Teach when to get help and where to get it – this goes beyond the ability of friendship to this goes beyond the ability of friendship to managemanage


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What Are Faculty What Are Faculty Responsibilities?Responsibilities?

Faculty members and others are seldom Faculty members and others are seldom mental health professionals, but may be mental health professionals, but may be mentors who can become aware of mentors who can become aware of students experiencing hopelessnessstudents experiencing hopelessness

As educators, we need to help students As educators, we need to help students become more aware of symptoms that become more aware of symptoms that might mean they need treatmentmight mean they need treatment

This means educating ourselves to know This means educating ourselves to know what the symptoms of depression and what the symptoms of depression and suicidal thinking are, and becoming able suicidal thinking are, and becoming able to move past the centuries old taboo to move past the centuries old taboo against talking about these problems as against talking about these problems as something other than an illnesssomething other than an illness


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Faculty Must React Faculty Must React AppropriatelyAppropriately

Training is needed so that faculty Training is needed so that faculty will not under-react to suicidal will not under-react to suicidal referencesreferences

Training to understand what depression Training to understand what depression is and how it can lead to suicideis and how it can lead to suicide

Realizing that relationship and support is Realizing that relationship and support is not enough – we don’t simply offer not enough – we don’t simply offer kindness when someone is having a kindness when someone is having a heart attackheart attack


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Mentoring and ConnectionMentoring and Connection

One of the triggering factors to depression is One of the triggering factors to depression is isolation, the feeling of not being a part of a isolation, the feeling of not being a part of a communitycommunity

College students still need adult support and College students still need adult support and someone to talk withsomeone to talk with

Faculty and students alike need training in Faculty and students alike need training in these issues, but stigma makes it difficult for these issues, but stigma makes it difficult for people to talk openlypeople to talk openly

Try a stress-management seminarTry a stress-management seminar Talk about relationship issues, as many suicidal Talk about relationship issues, as many suicidal

thoughts come up as a response to relationship thoughts come up as a response to relationship lossloss

Don’t be afraid to bring up suicide in any Don’t be afraid to bring up suicide in any appropriate discussion settingappropriate discussion setting


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What On Earth Can What On Earth Can II Do? Do?

We are reluctant to ask questions of We are reluctant to ask questions of depressed students because we feel it is depressed students because we feel it is “none of my business”, or fear the “none of my business”, or fear the responsibilityresponsibility

Depression is an illness, like heart Depression is an illness, like heart disease, and disease, and suicidal thoughts are a suicidal thoughts are a crisis, like a heart attackcrisis, like a heart attack

Anyone can learn to ask the right Anyone can learn to ask the right questions to help a depressed and questions to help a depressed and suicidal personsuicidal person


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What Stops Us?What Stops Us?

Most of us still believe suicide and depression Most of us still believe suicide and depression are “none of our business”are “none of our business”• Most are fearful of getting a yes answerMost are fearful of getting a yes answer• What if we knew how to respond to “yes”?What if we knew how to respond to “yes”?• What if we could recognize depression What if we could recognize depression

symptoms like we recognize symptoms of a symptoms like we recognize symptoms of a heart attack?heart attack?

• What if we were no longer afraid to ask for What if we were no longer afraid to ask for help for ourselves, our parents, our children?help for ourselves, our parents, our children?

• What if we recognized our feelings of What if we recognized our feelings of despair and hopelessness, as symptoms of a despair and hopelessness, as symptoms of a brain disorder?brain disorder?


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Learning “Learning “QPRQPR” – Or, How To ” – Or, How To Ask The “S” QuestionAsk The “S” Question

It is essential, if we are to reduce the It is essential, if we are to reduce the number of suicide deaths in our country, number of suicide deaths in our country, that community members/gatekeepers learn that community members/gatekeepers learn ““QPRQPR””

First identified by dr. Paul Quinnett as an First identified by dr. Paul Quinnett as an analogue to CPR, “analogue to CPR, “QPRQPR” consists of ” consists of QQuestion – asking the “S” questionuestion – asking the “S” questionPPersuade– getting the person to talk, and to ersuade– getting the person to talk, and to

seek helpseek helpRRefer – getting the person to professional helpefer – getting the person to professional help

(Quinnett, 2000)(Quinnett, 2000)


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Ask Questions!Ask Questions! Ask questions about suicide like, "Do you ever �Ask questions about suicide like, "Do you ever �

• have thoughts of hurting yourself? have thoughts of hurting yourself? • feel so badly that you have thoughts of dying? feel so badly that you have thoughts of dying? • wish you could runaway or disappear? wish you could runaway or disappear? • wish you could go to sleep and not wake up? wish you could go to sleep and not wake up? • have scary dreams about dying? have scary dreams about dying?

Remember, you cannot make someone Remember, you cannot make someone suicidal by talking about it. If they are already suicidal by talking about it. If they are already thinking of it they will probably be relieved thinking of it they will probably be relieved that the secret is out.that the secret is out.

If you get a yes answer, don’t panic. Ask a few If you get a yes answer, don’t panic. Ask a few more questions. more questions.


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Reduce StigmaReduce Stigma

Knowing what to ask and where to get help is Knowing what to ask and where to get help is not enoughnot enough

Reducing the fear and shame we carry about Reducing the fear and shame we carry about having such “shameful” problems can only be having such “shameful” problems can only be done through a public health approachdone through a public health approach

Shame keeps people from seeking help or Shame keeps people from seeking help or talking about their paintalking about their pain

Teach people that depression is truly a Teach people that depression is truly a disorder that can be treated – a deadly killer disorder that can be treated – a deadly killer that we can no longer ignore or fear that we can no longer ignore or fear discussingdiscussing


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Do . . .Do . . .

Talk openly- reassure them that Talk openly- reassure them that they can be helped - Try to instill they can be helped - Try to instill hope hope

Encourage expression of feelings – Encourage expression of feelings – say “Tell me more”say “Tell me more”

Listen without passing judgmentListen without passing judgment Make empathic statementsMake empathic statements Use warning signs to get helpUse warning signs to get help early for the individual,early for the individual, Stay calm, relaxed, rationalStay calm, relaxed, rational


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Don’t…Don’t…

Make moral judgments– don’t argue or lectureMake moral judgments– don’t argue or lecture Encourage guiltEncourage guilt Promise total confidentiality/offer reassurances that Promise total confidentiality/offer reassurances that

may not be truemay not be true Offer empty reassurances – “you’re luckier than Offer empty reassurances – “you’re luckier than

most people” won’t helpmost people” won’t help Minimize the problem/offer simplistic solutions(e.g. Minimize the problem/offer simplistic solutions(e.g.

“all you need is a good night’s sleep”)“all you need is a good night’s sleep”) Dare the suicidal person (e.g.“You won’t really do Dare the suicidal person (e.g.“You won’t really do

it.”)it.”) Use reverse psychology (e.g. “Go ahead and kill Use reverse psychology (e.g. “Go ahead and kill

yourself.”)yourself.”) Leave the student aloneLeave the student alone


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Never Go It Alone!Never Go It Alone!

Get help!!!Get help!!! A friend: go to a teacher, your parent, their parents, a A friend: go to a teacher, your parent, their parents, a

counselor, a pastorcounselor, a pastor If it is you – ask for help right now! Talk with:If it is you – ask for help right now! Talk with:

• Family and friendsFamily and friends• School PersonnelSchool Personnel• Crisis HotlineCrisis Hotline• Community AgenciesCommunity Agencies• Family doctorFamily doctor• ClergyClergy

If it is your parent/grandparent – get adult help – If it is your parent/grandparent – get adult help – Clergy, Guidance counselor, crisis line, family doctorClergy, Guidance counselor, crisis line, family doctor


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Local Professional Local Professional ResourcesResources

College College CounselorsCounselors

Staff nursesStaff nurses

Local Crisis Local Crisis HotlinesHotlines

Local ClergyLocal Clergy

911911

Hospital Emergency RoomHospital Emergency Room

Local Mental Health Local Mental Health AgenciesAgencies

Local Mental Health Local Mental Health BoardBoard

National Crisis HotlinesNational Crisis Hotlines

PhysiciansPhysicians

Local Police/SheriffLocal Police/Sheriff


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After A SuicideAfter A Suicide

Schools should prepare postvention plans in case Schools should prepare postvention plans in case a suicide does occur on campusa suicide does occur on campus

Plans should focus on outreach to survivors and Plans should focus on outreach to survivors and prevention of suicide contagion by managing prevention of suicide contagion by managing information that is presented to the press and information that is presented to the press and publicpublic

Opportunities to talk should be made available to Opportunities to talk should be made available to students and staffstudents and staff

Connections should be maintained with other Connections should be maintained with other students who are known to have suicidal students who are known to have suicidal thoughts, and with friends of the person who diedthoughts, and with friends of the person who died


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Permanent Solution-Permanent Solution-Temporary ProblemTemporary Problem

Remember a depressed person is physically Remember a depressed person is physically ill, and ill, and cannotcannot think clearly about right or think clearly about right or wrong, wrong, cannot cannot think logically about their think logically about their value to friends and familyvalue to friends and family

You would try CPR if you saw a heart attack You would try CPR if you saw a heart attack victim. Don’t be afraid to “interfere” when victim. Don’t be afraid to “interfere” when someone is dying more slowly of depressionsomeone is dying more slowly of depression

Most students, when treated, are able to Most students, when treated, are able to overcome their suicidal thoughts, and recover overcome their suicidal thoughts, and recover from their depressionfrom their depression

Depression is a treatable disorderDepression is a treatable disorder Suicide is a preventable deathSuicide is a preventable death


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Websites For Additional Websites For Additional InformationInformation

National Suicide National Suicide Prevention Lifeline Prevention Lifeline at 1-800-273-TALK at 1-800-273-TALK (8255)(8255)

NAMINAMIwww.nami.orgwww.nami.org

National Institute of Mental National Institute of Mental HealthHealthwww.nih.nimh.govwww.nih.nimh.gov

American Association of American Association of SuicidologySuicidologywww.suicidology.orgwww.suicidology.org

Suicide Prevention Suicide Prevention Resource Center Resource Center www.sprc.orgwww.sprc.org

Suicide Suicide Awareness/Voice of Awareness/Voice of EducationEducation

www.save.orgwww.save.org American Foundation American Foundation

for Suicide Preventionfor Suicide Prevention

www.afsp.orgwww.afsp.org Suicide Prevention Suicide Prevention

Advocacy Network Advocacy Network

www.spanusa.orgwww.spanusa.org


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College Prevention College Prevention WebsitesWebsites

Campus BluesCampus Blues ( (http://http://www.campusblues.comwww.campusblues.com) features ) features information and resources for college students on mental information and resources for college students on mental health, anxiety, loneliness, alcohol abuse, gambling, and other health, anxiety, loneliness, alcohol abuse, gambling, and other social and emotional issuessocial and emotional issues

Go Ask Alice! Go Ask Alice! ((http://http://www.goaskalice.columbia.eduwww.goaskalice.columbia.edu//) is a web-) is a web-based health question-and-answer service produced by Alice!, based health question-and-answer service produced by Alice!, Columbia University's Health Education Program. Go Ask Columbia University's Health Education Program. Go Ask Alice! provides information to help young people make better Alice! provides information to help young people make better decisions concerning their health and well-being. Go Ask Alice! decisions concerning their health and well-being. Go Ask Alice! answers questions about relationships, sexuality, emotional answers questions about relationships, sexuality, emotional health, alcohol and other drugs, and other topics. The health, alcohol and other drugs, and other topics. The addresses of e-mails sent to Go Ask Alice! are electronically addresses of e-mails sent to Go Ask Alice! are electronically scrambled to preserve the senders' confidentiality. Questions scrambled to preserve the senders' confidentiality. Questions are answered by a team of Columbia University health are answered by a team of Columbia University health educators and information and research specialists from other educators and information and research specialists from other health-related organizations. The Go Ask Alice! archive on health-related organizations. The Go Ask Alice! archive on emotional health also contains information on suicide and emotional health also contains information on suicide and depression.depression.


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College Prevention College Prevention WebsitesWebsites

Ulifeline.org Ulifeline.org ((http://http://www.ulifeline.orgwww.ulifeline.org) is a web-based ) is a web-based resource created by the Jed Foundation to provide students resource created by the Jed Foundation to provide students with a non-threatening and supportive link to their college's with a non-threatening and supportive link to their college's mental health center as well as important mental health mental health center as well as important mental health information. Students are able to download information about information. Students are able to download information about various mental illnesses, ask questions, make appointments, various mental illnesses, ask questions, make appointments, and seek help anonymously via the Internet. Resources and seek help anonymously via the Internet. Resources offered on Ulifeline.org include a customized version of Go offered on Ulifeline.org include a customized version of Go Ask Alice! that allows students to have virtually any mental Ask Alice! that allows students to have virtually any mental health question answered 24 hours a day; a mental health and health question answered 24 hours a day; a mental health and drug information library that features consumer health drug information library that features consumer health information from Harvard Medical School; and the Duke information from Harvard Medical School; and the Duke Diagnostic Psychiatry Screening Program, which allows the Diagnostic Psychiatry Screening Program, which allows the Ulifeline user to be screened for different mental disorders. Ulifeline user to be screened for different mental disorders. While this screening is not meant to take the place of an While this screening is not meant to take the place of an evaluation by a mental health professional, a positive result evaluation by a mental health professional, a positive result suggests that the student would benefit from comprehensive suggests that the student would benefit from comprehensive mental health screening mental health screening


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And Finally…And Finally…

If one cannot state a matter clearly If one cannot state a matter clearly enough so that even an intelligent enough so that even an intelligent twelve-year-old can understand it, twelve-year-old can understand it, one should remain within the one should remain within the cloistered walls of the university and cloistered walls of the university and laboratory until one gets a better laboratory until one gets a better grasp of one's subject mattergrasp of one's subject matter

Margaret MeadMargaret Mead


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A Brief BibliographyA Brief Bibliography

American Foundation for Suicide Prevention (AFSP) has American Foundation for Suicide Prevention (AFSP) has launched the College Screening Project - a pilot program launched the College Screening Project - a pilot program aimed at identifying college students at risk for suicide and aimed at identifying college students at risk for suicide and

encouraging them to get help they needencouraging them to get help they need Anderson, E. “The Personal and Professional Impact of Client Anderson, E. “The Personal and Professional Impact of Client

Suicide on Mental Health Professionals. Unpublished Suicide on Mental Health Professionals. Unpublished Doctoral dissertation, U. of Toledo, 1999Doctoral dissertation, U. of Toledo, 1999

Berman, A. L. & Jobes, D. A. (1996) Berman, A. L. & Jobes, D. A. (1996) Adolescent Suicide: Adolescent Suicide: Assessment and InterventionAssessment and Intervention..

Blumenthal, S.J. & Kupfer, D.J. (Eds) (1990). Blumenthal, S.J. & Kupfer, D.J. (Eds) (1990). Suicide Over the Suicide Over the Life Cycle: Risk Factors, Assessment, and Treatment of Life Cycle: Risk Factors, Assessment, and Treatment of Suicidal Patients.Suicidal Patients. American Psychiatric Press. American Psychiatric Press.

Jacobs, D., Ed. (1999). Jacobs, D., Ed. (1999). The Harvard Medical School Guide to The Harvard Medical School Guide to Suicide Assessment and Interventions.Suicide Assessment and Interventions. Jossey-Bass. Jossey-Bass.


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Jamison, K.R., (1999). Jamison, K.R., (1999). Night Falls Fast: Understanding Suicide.Night Falls Fast: Understanding Suicide.

Alfred KnopfAlfred Knopf Lake, P. (2002). The Emerging Crisis of College Student Suicide: Lake, P. (2002). The Emerging Crisis of College Student Suicide:

Law and Policy Responses to Serious Forms of Self-Inflicted InjuryLaw and Policy Responses to Serious Forms of Self-Inflicted InjuryStetson Law Review, Vol. 32, No. 1, 2002Stetson Law Review, Vol. 32, No. 1, 2002

Lester, D. (1998). Lester, D. (1998). Making Sense of Suicide: An In-Depth Look at Making Sense of Suicide: An In-Depth Look at Why People Kill Themselves.Why People Kill Themselves. American Psychiatric Press American Psychiatric Press

Oregon Health Department, Prevention. Notes on Depression and Oregon Health Department, Prevention. Notes on Depression and Suicide: Suicide: ttp://www.dhs.state.or.us/publickhealth/ipe/depression/notes.cfmttp://www.dhs.state.or.us/publickhealth/ipe/depression/notes.cfm

Putukian, M. & Wilfert, M, 2004.Putukian, M. & Wilfert, M, 2004. Student Athletes Also Face Dangers Student Athletes Also Face Dangers From DepressionFrom Depression http://www.ncaa.org/news/2004/20040412/active/4108n32.htmlhttp://www.ncaa.org/news/2004/20040412/active/4108n32.html

Pavela, G. (2006) College Student Suicide: Legal IssuesPavela, G. (2006) College Student Suicide: Legal Issues President’s New Freedom Council on Mental Health, 2003President’s New Freedom Council on Mental Health, 2003 Quinnett, P.G. (2000). Quinnett, P.G. (2000). Counseling Suicidal People.Counseling Suicidal People. QPR Institute, QPR Institute,

Spokane, WASpokane, WA Schneidman, E.S. (1996). Schneidman, E.S. (1996). The Suicidal MindThe Suicidal Mind. Oxford University . Oxford University

Press. Press. Schwartz AJ and Whitaker LC. Suicide among college students: Schwartz AJ and Whitaker LC. Suicide among college students:

Assessment, treatment and intervention. In SJ Blumenthal & DJ Assessment, treatment and intervention. In SJ Blumenthal & DJ Kupfer (Eds) Suicide over the life cycle: Risk factors, assessment, Kupfer (Eds) Suicide over the life cycle: Risk factors, assessment, and treatment of suicidal patients. (pp. 303-340). Washington DC: and treatment of suicidal patients. (pp. 303-340). Washington DC: American Psychiatric Press, 1990.American Psychiatric Press, 1990.


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Signs of Depression in Youth.Signs of Depression in Youth. Oregon State Dept. of Oregon State Dept. of Health. Health. http://http://www.dhs.state.or.us/publichealthwww.dhs.state.or.us/publichealth//

ipe/depression/signs.cfmipe/depression/signs.cfm Stoff, D.M. & Mann, J.J. (Eds.), (1997). Stoff, D.M. & Mann, J.J. (Eds.), (1997). The The

Neurobiology of SuicideNeurobiology of Suicide. American Academy of Science. American Academy of Science Styron, W. (1992). Styron, W. (1992). Darkness VisibleDarkness Visible. Vintage Books. Vintage Books

Surgeon General’s Call to Action (1999). Department Surgeon General’s Call to Action (1999). Department

of Health and Human Services, U.S. Public Health of Health and Human Services, U.S. Public Health Service.Service.

Tang, T.Z. & De Rubeis, R.J. ((1999). “Sudden Gains Tang, T.Z. & De Rubeis, R.J. ((1999). “Sudden Gains

and critical sessions in cognitive-behavioral therapy for and critical sessions in cognitive-behavioral therapy for depression”. depression”. Journal of Consulting and Clinical Journal of Consulting and Clinical Psychology 67: 894-904.Psychology 67: 894-904.

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