The purpose of choosing the topic of suicide ideation, suicide attempt and suicide related to children and youth is due to the increasing number of children and adolescent students who I have encountered that attend the New York City Public School System. The students’ parents have also reported their children having discussions regarding suicidal ideation or having attempted suicide. This is quite alarming and school personnel face enormous challenges to support children and families who are also experiencing such unsettling challenges.
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Some of the challenges include connecting families to agencies/resources for mental health services particularly when they do not have insurance or when their insurance is not accepted. Also, the lack of school personnel trained in mental health, lack of an awareness and adherence of the citywide and district-wide protocol for prevention and intervention related to childhood and youth suicide. In addition, parental participation in learning opportunities to identify signs and take pre-emptive measures to prevent childhood and adolescent suicide. Children and youth dying by suicide is quite preventable and all individuals working with children have to make a concerted effort to understand the nature and impact suicide of a child has on all involved in their lives. Parents and educators owe it to all children to have a happy childhood where they are able to live productive lives carefree of many adult-like life stressors. We must be mindful that suicide robs children and youth of very important milestones such as prom, graduation, attending college, ability to achieve career aspirations, marriage, children and grandchildren. It also deprives parents and family members of having the opportunity to partake in those momentous occasions. However, in order for professionals and school personnel to effectively support children and their families there as to be a level of transparency by all parties involved.
Such candid discussions can result in acquiring intensive intervention for recovery and positive outcomes. Shaffer & Fisher (1981) “reported the term “childhood suicide” is used to define a self-inflicted death occurring before a child’s 15th birthday, and “adolescent suicide” is such a death occurring between ages 15 and 19. These are the age groupings used by the National Center for Health Statistics and the World Health Organization (p. 546). The Center for Disease Control and Prevention (CDC, 2016) defines suicide as death caused by self-directed injurious behavior with an intent to die as a result of the behavior. Suicide attempt is considered a non-fatal, self-directed, potentially injurious behavior with an intent to die as a result of the behavior that may not result in injury. Whereas, suicidal ideation are thoughts about, considering, or planning suicide. Suicidal thoughts can lead to suicide attempts which can result in suicide for many young adults. It is important to try to understand the family dynamics and what is going on in the lives of young adults to prevent them from taking such drastic measures to end their life. Most often, young adults understand dying, but it is uncertain if they fully understand at times that death is eternal. According to the report by the CDC (2018), there has been an increase in the rate of suicide in almost every state. In 2016, nearly 45,000 Americans died by suicide in which there was a death every 12 minutes (CDC, 2018). Suicide is considered the 10th leading cause of death and one of the primary causes of death in the United States. In 2016, 9.8 million American adults seriously thought about suicide, 2.8 million made a plan, and 1.3 million attempted suicide CDC (2018).
In 2016, suicide was second in the leading cause of death for 15-24-year-old. In addition, youth suicide is considered a serious public health problem and is the second leading cause of death among individuals 10 to 14 years of age CDC (2017). Many states have initiated policies to promote suicide prevention for youth, but it appears we still have a tremendous amount of work to do considering suicide is the second leading cause of death among youth. CDC (2017), report the most recent youth risk and behavior survey found that in the preceding year among high school students: 17.7% seriously considered suicide; 14.6% made a plan for suicide; 8.6% attempted suicide one or more times; 2.8% made a suicide attempt that had to be treated by a doctor or nurse. According to the CDC (2017), girls are more likely to attempt suicide, but boys ae 4.34 times more likely die by suicide than girls. Among age 15-24, 4,550 Caucasians, 686 African Americans, 316 Asian/Pacific Islanders and 171 Native Americans died by suicide during 2016 CDC (2017). In addition, 51.3% of males age 15-24 used firearms to take their life and 34.8% used suffocation; However, among females 44.3% die by suffocation compared to 29.2% by firearm CDC (2017). Firearms have traditionally been the leading suicide method among U.S. youth, followed by hanging/suffocation, and self-poisoning (Bridge, Goldstein & Brent, 2006). Research indicates males tend to engage in more violent or aggressive acts than females to harm themselves. Shaffer & Fisher (1981) reported “a child’s or adolescent’s death by suicide is seen as more shocking and disturbing than a child’s death from cancer or traffic accident” (p. 545). Regardless of the method, any death of a child is tragic and devasting for family and friends to process. Child and adolescent suicide is a complex global public health problem that has intrigued researchers, academicians and policy makers for decades (Nazeer, 2016).
Youth who attempt suicide generally do not have effective coping mechanisms and tend to deal with their emotional pain by harming themselves, because of the depth of their emotional trauma. Most often, they do not consider the impact their death would have on family and friends. However, it also depends on the relationship one may have with their parents as death maybe a way in which a youth can be seeking sympathy from their parents or revenge toward them. History of Suicide Berman (2009) reported “the problem of adolescent suicide has vexed and perplexed social scientists for more than a century. Meeting in his living room in 1910, Sigmund Freud chaired the discussion among a distinguished panel of interdisciplinary scholars from the Vienna Psychoanalytic Society in attempt to understand and propose solutions to an observed and alarming increase in suicides among your students” (p. 233). (Nazeer, 2016) indicated United States adolescent suicide rate gradually increased during the 20th century, becoming more marked during the 1960s and reaching an overall peak in the 1990s. Although the adolescent suicide rates stabilized during the late 1990s, they had increased by 25% between 1960 and 1980 and doubled between 1960 and 2001. Since the late 1990s, the suicide rate has declined, reaching a 30 year low in 2003 (McLoughlin & Malone, 2015). However, an increase was noted by 2005. In addition, CDC (2018) report, suicide rate among United States youth, ages 10 to 17, increased by 70 percent between 2006 and 2016. Although many schools have trained personnel such as guidance counselors, social workers and school psychologists, discussing the topic of suicide with students may pose as a challenge for several clinicians. (Pettit, Buitron & Green, 2018) report “clinicians are sometimes reluctant to broach the topic of suicide with youth due to concerns that talking about suicide might inadvertently create a risk that was not already present or might damage rapport with client” (p. 1).
However, if it is suspected that there are concerns related to children self harming or attempting suicide, a risk assessment should be conducted with the student. The risk assessment can be administered by a counselor, school psychologist, social worker and/or mental health personnel. There are different types of risk assessments though the purpose of the risk assessment is to determine if the individual is at a low or high risk for suicide and if they have a plan of action based on several questions presented for them to answer. The outcome of the risk assessment should be discussed with the student’s parents and administrator to determine next steps for the student. Risk Factors Individuals working with youth should be aware of the various risk factors that may increase the risk of suicide. It is important for school personnel to identify such risks factors in order to follow up with individuals who are at risk of harming themselves. It is important to be aware of the multiple reasons why a child or adolescent will self-harm, attempt or want to die by suicide. There is no one particular reason and individuals that are at-risk may have similar and/or different risk factors which can have a tremendous impact on their life based on their inability to handle specific stressors. Several of the risks factors include: 1). Feeling a sense of loneliness or isolation (not feeling connected in the presence of family and friends); 2). Family stressors (unemployment, domestic violence, poverty); 3). History of suicide in the family (parents or close family members); 4). Mental Health Illness (anxiety, depression or eating disorder;); 5). Self-injurious behavior (cuts, burns, scratches, and scabs); 6). Previous suicide attempts (individual has attempted suicide before); 7). Environmental hazard (firearm in home).
While there are risk factors one should be aware of, there are also warning signs which are sometimes evident. Warning Signs Although it is important to understand the risk factors, it is equally essential to be cognizant of the warning signs of student at risk of suicide. Many adolescents who have thoughts about suicide often have demonstrated observable warning signs. The warnings signs should not be disregarded and should be taken seriously and require immediate attention. One must be aware that situation that maybe small to one individual, maybe overwhelming for another individual. There are several warning signs that are not limited to the following: Being preoccupied with dying, departing of close and treasured possessions, become withdrawn from friends and/or family, writing suicide notes (also on social media), hurting self, attempted before, creating a plan to commit suicide, changes in behavior, hygiene, sleep patterns, appearance, emotions, making specific comments about killing oneself, substance abuse, concerns regarding sex orientation, mental health issues, doing poorly in school or feeling academic pressure to do well in school, and situational crisis that can be due to an unhealthy relationship, ending a relationship, loss of a loved one; physical/verbal/sexual abuse, feeling bullied or harassed. Social media The U.S. Department of Education (2012) defines social media as “forms of communication either internet or text-based that support social interaction of individuals” (p. 5). Many youths live their lives through social media. Social media can be two-fold, negative at promoting or idealizing suicide; meanwhile, positive in preventing the suicide of a young adult or others.
Social media can have a negative or positive effect on individuals who are at risk of suicide. Cyberbullying can expose children to unwanted attention and distress because of negative postings, embarrassing pictures, threats in which their peers also have access to the information. However, it can be an avenue for an individual who may be feeling lonely to have a sense of community. It can also serve as a tool which can be readily utilized to help someone in crisis get support or prevent them from harming themselves. Prevention Research has indicated that suicide is preventable. However, it remains the second leading cause of death of adolescents. There are National and State efforts to provide preventive services to combat the epidemic of death caused by suicide of young individuals. Jason Flatt is a young male who died by suicide. “Jason Flatt has been the driving force behind the Jason Flatt Act (JFA), first adopted in Tennessee and now a law in 19 States” (Lieberman & Poland, 2017). The JFA is a legislation that was enacted in 2007. The JFA legislation proposed two-hour trainings in awareness and suicide prevention on a yearly basis for educators to continue to teach. Since 2007, twenty-seven states require staff training in suicide prevention but only 10 require that training be conducted annually (Lieberman & Poland, 2017). Moreover, school administration are the leaders in their school building and are obligated to keep children safe in a welcomed and supportive learning environment. School personnel have a legal and ethical responsibility to protect children. Thus, school personnel have to be proactive to identifying and taking action when children who are known to be at-risk show warning signs of exhibiting suicidal behavior. It is imperative for school personnel to have the knowledge and training to readily address the needs of student’s at-risk for suicide.
School personnel must also be aware of the school procedures for working with children and families in crisis. There should preventive and intervention in all schools to recognize and help decrease the risk factors related to childhood and youth suicide. The guidelines developed should include a team approach and collaboration with many stakeholders. School personnel must be mindful that suicidal ideation and suicidal attempt is another way in which youth can communicate their need for attention or support. Therefore, it is essential to understand the core of the adolescent’s emotional distress. Some youth feel their emotional pain is so devastating in which death is the only solution. Despite, support with dealing with their internal issues, sometimes death is the only foreseeable option they perceive as a means to escape their situation. Many young adults are unable to adequately problem solve and are too young to comprehend everyone experience a crisis which is impermanent and can be resolved over time. There is a city-wide initiative through the New York City Department of Education in which the New York City Chancellor Regulation for suicide prevention and intervention went into effect January 20, 2011 for all New York City Public schools to address the issue of suicide in schools. The preventative measures consist of having a crisis team in which staff should know the members of the team as well as their role and responsibilities. All school crisis teams should entail, but not be limited to an administrator, counselor, social worker, school psychologist, and teachers.
Members of the crisis team should be trained and be able to conduct an at-risk of assessment to determine if student is an elevated level of harming themselves. The crisis team is responsible for creating a school crisis intervention plan that is inclusive of prevention and intervention education as well as follow up after intervention. School personnel must be aware of the prevention-education and intervention via orientation that should be conducted within the first two weeks of the start of the school year. There should also be professional learning opportunities for all staff to understand the ladder of referral, at-risk and warning signs of students who may possibly be suicidal. There should be student-centered awareness for adolescents for them to have a sense of awareness of consequences of suicide, school personnel to contact for themselves or peers for support. The crisis team is responsible for providing students and families training and resources for students and families related to suicide. The crisis team should collaborate with community-based organizations, hospital or mental health agencies to in order to refer students for support beyond the scope of what school can manage.
Intervention School personnel should be aware of the ladder of referral in their school to report behavior associated with acts of suicidal behavior. Although a student may ask that such actions remain confidential, school personnel must inform school administration when if they suspect a student is possible or attempting suicide. School personnel must ensure the safety of the student and understand adult supervision is required in which parents are to be notified as well as the emergency personnel for assistance. Post-interventions should entail follow-up with psychiatrist, agencies, mental health organizations, hospital personnel to find out about any diagnosis, type of treatment and the type of support and/or what needs to be implemented at the school level by school personnel to support student(s). There should be on-going communication and consultation with the student and family. Provide counseling and other services during the school day or afterschool. Connecting family to resources and services based on the needs of the student and/or family. Postvention Families and school personnel should be aware of suicide postvention which is described as the provisions of crisis intervention, support and assistant for those affected by a completed suicide (American Association of Suicidology, 1998).
Postvention is vital for any child or adolescent who may be at risk of harming themselves in order to provide intervention to prevent them from replicating suicidal behavior that can result in contagion. Zenere (2009) reports, according to the (U.S. Department of Health & Human Services, 2008), contagion is the process by which suicidal behavior or suicide influences an increase in the suicidal behaviors of contagion can occur based on geographical proximity (the physical distance in which individual encountered suicide incident), psychological proximity (the level of connection one had with victim), social proximity (the relationship one had with the victim) and population at risk encompasses (individual who are susceptible due to other risk factors) (p. 12-13). Resources for Individuals who Exhibit Suicide Behavior It is extremely important for school personnel, especially school social workers, guidance counselors, school psychologists, and the crisis team are equipped with the local and national resources.
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