Oakland County Youth Prevention Task Force

School Toolkit

Developed by the Oakland County Prevention Task Force Talk to Someone You Trust Oakland County Youth Task Force

Dear School Personnel:

In an eff ort to assist youth struggling with issues related to suicide, this suicide preven on toolkit was developed to encourage schools to be proac ve in crea ng and implemen ng a suicide preven on policy. Oakland County Department of Health and Human Services, Oakland County Community Mental Health Authority, Oakland Schools, Easter Seals, Common Ground and Training and Treatment Innova ons have partnered for this ini a ve.

Suicide, mental illness and substance use are closely related issues. According to the Na onal Ins tute of Mental Health, almost all people who take their own lives have a diagnosable mental health or substance use disorder. If these disorders are iden fi ed and treated, death by suicide can be prevented.

Promo ng awareness that suicide is a public health issue and reducing the s gma associated with obtaining mental health services are two goals outlined in the Oakland County Youth Suicide Preven on Plan. As part of our eff orts to work toward these goals, the task force has created a toolkit outlining recommended components of a school suicide preven on program and school suicide preven on resources. We hope this will be helpful in crea ng a plan to meet your school’s needs. Your school is an important partner in preven ng youth suicide.

It’s our responsibility to arm our children with the informa on they need to protect themselves. You can save lives by ge ng the message out.

Thank you for your help,

L. Brooks Pa erson Oakland County Execu ve Table of Contents

IIntroductionntroduction

IIntroductionntroduction ttoo SSuicideuicide PPreventionrevention fforor SSchools...7chools...7 GGatekeeperatekeeper Training...9Training...9 OOaklandakland CCountyounty YYouthouth SSuicideuicide PPreventionrevention PPlan...11lan...11 PPosteroster Campaign...17Campaign...17

SSchoolchool PreventionPrevention PlanPlan

WWhathat SSchoolschools CanCan DoDo toto PreventPrevent Suicide...Suicide... 2233 CChecklisthecklist ofof SuicideSuicide PreventionPrevention Activities...25Activities...25 SStepsteps FForor GGettingetting Started...27Started...27 SSchoolchool PreventionPrevention PlanPlan Worksheet...29Worksheet...29 SSchoolchool StaffStaff Assignments...31Assignments...31 DDevelopingeveloping ProtocolsProtocols ttoo HHelpelp SStudentstudents aatt RRiskisk fforor SSuicide...33uicide...33

SStudenttudent EEducationducation

SSchoolchool SuicideSuicide PreventionPrevention Programs...37Programs...37 TTeachingeaching AdaptiveAdaptive SkillsSkills toto Students...39Students...39

RResourcesesources

TTalkingalking PointsPoints forfor Staff...43Staff...43 SSuicideuicide InterventionIntervention ProtocolProtocol CCharthart fforor SStaff...45taff...45 CCrisisrisis LLinesines aandnd OOtherther RResources...47esources...47 SStafftaff CCrisisrisis TTeameam RRecruitmentecruitment LLetter...49etter...49 PParentarent CCrisisrisis TTeameam RRecruitmentecruitment LLetter...50etter...50 PParentarent EEducation...51ducation...51 PParentarent SSuicideuicide PPreventionrevention TTipip SSheet...53heet...53

IImportantmportant FFactsacts ttoo KKnownow AAboutbout SSuicideuicide

WWarningarning SSignsigns fforor SSuicideuicide aandnd HHowow ttoo RRespond...57espond...57 RRiskisk FFactors...59actors...59 PProtectiverotective FFactors...60actors...60 EEmergingmerging IIssues...63ssues...63 TThehe ImplicationImplication ooff CCultureulture oonn SSuicideuicide PPrevention...67revention...67 GGlossary...69lossary...69

Content adapted from SAMHSA’s Preventing Suicide: A Toolkit for High Schools, U.S. Surgeon General and the National Action Alliance for Suicide Prevention’s 2012 National Strategy for Suicide Prevention, University of Oregon Counseling Center and University of South Florida’s Youth Suicide Prevention School-Based Guide Introduction

Introduction to Suicide Prevention for Schools...7

Gatekeeper Training...9

Oakland County Youth Suicide Prevention Plan...11

Poster Campaign...17

Developed by the Oakland County Youth Suicide Prevention Task Force Talk to Someone You Trust • • • • revealed monthsprecedingthesurvey: thatinthe12 takes amongAmerica’s youth. Datafrom the2009Youth RiskBehavior Survey (YRBS) years ofage.Suicidedeathsrepresentonlyafractionthetoll13–19 thatsuicidalbehavior In 2009,suicidewas thethirdleadingcauseofdeathfor peopleofboth sexes and allraces can bedirected andefficiently. atstudents,facultyandparentseffectively point ofcontactfor almostallyouth. truewithsuicideprevention. Thisisparticularly Efforts Adolescent healthandwellness programs take often asthey placeinschools arethemain About Suicide Introduction to SuicidePrevention for Schools

risk prevention orhealthpromotion program. These programs whenimplemented areespecially effective inthecontext ofacomprehensive health conditions and encourage young peopleto recognize and find help for emotional issues. suicide preventionSchool-based programs include programs to screen students for mental suicide during the preceding 12 months. suicide duringthepreceding12 percent)having reported 7students(13.8 1outofevery seriouslyconsideredattempting 9students 1outofevery (10.9 percent) made a plan about how heor shewould attempt suicide. students (8.1 percent). female 22malestudents(4.6percent)This included1outofevery 12 and1outofevery attempted suicideatleastonce. having(6.3 percent) reported 16 1 outofevery students highschool percent) malestudents. 62(1.6 students and1outofevery 43(2.3percent)out ofevery female a doctor Thisincluded1 oranurse. was seriousenoughto betreated by having madeasuicideattempt that percent) reported students (1.9 53highschool 1outofevery

7 Introduction 8 Introduction Schools have beensuedfor negligencefor thefollowing reasons: additional tragedies Knowing whatto dofollowing asuicideiscriticalto copeandmay helpingstudents prevent academic performance Depression andother withtheabilityto mentalhealthissuescaninterfere learnandmay affect ofaschool’soverallA safe schoolenvironment mission ispart Why for Your Addressing SuicideisImportant School How to Respond onpage57. For more information refer to on identifyingandhelpingstudentsatrisk, Warning Signsand “normal” adolescentbehavior from suicidewarning signs. Teachers whoseeyouth andothers onadailybasisareinuniquepositionto distinguish • • • • • • • • •

violence prevention, ,wellness, alcoholanddrugabuse. Suicide prevention isconsistent to withmany protect other efforts studentsafety as such whiletheychildren care. are intheschool’s haveThere isanimplicitcontractthatschools withparentsto protect thesafety oftheir Failure to astudentatriskofsuicide adequately supervise Failure to get assistancefor astudentatriskofsuicide Failure to to notify appears parentsiftheirchild besuicidal ofsuicidesoccurringinasmallareaandbrieftimeperiod). numbers This may resultintherelatively rarephenomenonof“suicideclusters” (unusuallyhigh Adolescents can besusceptible to suicide contagion (sometimes called the“copycat effect”). received Asattempted suicide. 1 in5studentsreceivingDsandFsattempted suicide,while1in25studentswhomostly receiving mostlyAsfelt sadorhopeless. studentsreceivingDsandFsfelt50% ofhighschool sadorhopeless,while1in5students Gatekeeper Training increase aneducator’sknowledgeofthe single two-hourprogramcansubstantially students potentiallyatriskforsuicide.A drivers, nurses)aboutadolescentsuicide,particularlyhowtoidentify,intervene,and refer research suggeststhatitisbeneficialtotrainallschoolstaff(e.g.,coaches,cafeteriaworkers, bus In thepast,gatekeepertrainingfocusedprimarilyoneducatorsandadministrators.Recent teachers sampledinastudyreportedthattheyhadbeenapproachedbysuicidalteens. recognize astudentpotentiallyatriskforsuicide.Researchhasfoundthatmorethan25% of all Gatekeeper traininghasbeenfoundtoincreaseaneducator’sconfidenceintheirability Staff School component toasuicidepreventionprogram. supported byresearchasanessentialandeffective Gatekeeper trainingisuniversallyadvocatedand of riskandreferastudentwhoispotentiallysuicidal. and communicatewiththestudent,determinelevel potentially atriskforsuicide,appropriatelyintervene andparents,abouthowtorecognizeastudent staff who regularlyinteract with youth, includingschool Gatekeeper trainingreferstoallpeople presentation about howtolimit accessto methodsand toolsused forsuicide. information aboutsuicideprevention toparents.This presentationshould alsoincludeabrief and tobacco useinschools,isprobably themostefficient andeffectivemethod fordisseminating A oneandone-halfhour presentationcoupledwithotherpresentations, suchasalcoholabuse to help an adolescent and howto intervene witha youth potentially at risk for suicide. available schooland community resources about warning signs and riskfactors, facilitate dissemination ofinformation and staffgatekeeper training and should Parent training should be similar tofaculty Parents resources availableforadolescents. warning signs, risk factors, and community and thoseemployed inschools. pharmacists,caregivers, responders, Examples include clergy, first asappropriate. services supporting and refer themto treatmentor to atriskofsuicide identifypersons usual routine. They may betrained oftheir aspart community members of face contactwithlargenumbers in acommunitywhohave face-to- Gatekeepers arethoseindividuals

9 Introduction Oakland County Youth SuicidePrevention Task Force Youth SuicidePrevention Plan Oakland County May 2013 11 Introduction 12 Introduction • • • • • • Underlying principlesfor theOaklandCountyYouth SuicidePrevention Plan strengths andconstraintsofthecurrentpoliticaleconomicclimate. ofevolvingstakeholders. Theplanisbasedonanunderstanding bestpractices,aswell asthe County. willguideandimplementtheseactivitiesby engagingpublicandprivate Ourpartners This planhasbeendeveloped to focus andcoordinate inOakland suicideprevention efforts Oakland CountyYouth SuicidePrevention Planprocess INTRODUCTION workplaces. throughout ourcommunitiesincludingschools, correctionsatalllevels andinour Suicide prevention ofallourongoingwork mustbecomeapart andembedded the lifespan, across thestate andacross cultures. leadto positiveon recognizedbestpracticeswillensurethattheseefforts outcomesacross Significant investments oftimeand other resources arerequired to prevent suicide. Focusing componentofsuicidepreventioncommunities isanimportant efforts. Promoting healingandreducingriskfollowing asuicide(postvention) for both individualsand preventing suicide,butinimproving publichealthandsafety. Likewise, protectiverisk. communitiesthatbuildandsupport factors willbenefitnot justin Risk factors for canbeusedto ourcommunitiesaswell asfor designservices individualsat of suicidewillincreaseappropriate referrals andinterventions. of identifyingandgetting Broad thoseatriskinto awareness neededservices. ofwarning signs Prevention Theentirecommunitymustsharetheresponsibility mustbeacollaborative effort. treated. Earlyidentificationandaccess to careareessential. researchdemonstrates which illness and/orsubstanceusedisorders canbesuccessfully Suicide isgenerallypreventable. Thevast majorityofpeoplewhodieby suicidehave mental prevention. recognize suicideasagenerally preventable publichealthissue andareactively involved in Objective 1:Increasethenumberofcommunities,organizations andschools that preventable. Goal 1:Promote awareness thatsuicideisapublichealthissuegenerally COMMUNICATIONS &PUBLICEDUCATION • • listed onthebestpracticesregistry. a. Promote to implementpractices trainingandsupport helpcommunitieseffectively with high-riskpopulations,for recognizingandrespondingto suicidalbehavior. Objective 2:Promote communityandprofessional training,especiallyfor thosewhowork skills inscreeningfor suicidalrisk. Objective 1:Promote careproviders educationprograms effective to for primary increase interventions. and theuseofeffective Goal 1:Educate professionals andorganizationsto improve recognitionofat-riskbehaviors GATEKEEPER TRAINING a. Listbestpracticesfor suicideprevention andthepublic. for useby communitypartners forObjective suicideprevention 2:Maintainaresource library ontheTask Force website. (includingsuppressionofsmallernumbers). b. Create ofguidelinesfor anddisseminate appropriate asummary releaseofdata a. Create, expand, andimprove onsuicideto methods for reporting increasedatasources. Objective 1:Obtaindataonsuicideandattempts to make available to partners. Goal 1:Maintainaclearinghousefor suicidedataandprevention resources. DATA COLLECTION ANDANALYSIS part of each organization’sexisting ofeach emergencyresponseplan. part Encourage thedevelopment andinclusionofprotocols thataddresssuicidalevents as Promote trainingto emergencyworkers whoareimpacted by suicideevents.

13 Introduction 14 Introduction suicide attempts in survivors ofsuicide. suicide attempts insurvivors Objective 2:Promote crisisinterventionthatdecreasesthelikelihood ofsuicidalbehavior or Group.c. Promote ofSuicideSupport CommonGround’s Survivors annualteleconference ofSuicide. for Survivors b. Promote CommonGround’s event, theAmericanFoundation for SuicidePrevention (AFSP) maintainthelistofresources for support. Bereavementa. Create packet aSuicideSurvivors for theMedicalExaminer to distribute and andeducationprogramsObjective for 1:Implementsupport suicidesurvivors. ofsuicide. survivors Goal 3:Support abuseandsuicide. c. Provide for thepublicto opportunities hearfrom thoseaffected by mentalillness,substance treatmentsfor thatthereareeffective mentaldisorders. b. Disseminate information to legislators, policymakers, providers andthepublicdemonstrating addressingsuicideopenlycanprevent suicidalbehaviors. a. Educate thepublicandkey gatekeepers withmentalillnessand thatacceptanceofpersons takingresponsibilityfor aspersons theiroverall health. oftheseservices consumers equal andinseparablecomponentsofoverall health,andthatrespondto specifictreatmentsand ofthepublicthatviews asrealillnesses, Objective mentaldisorders 1:Increasetheproportion Goal 2:Reduce stigma related to obtainingmentalhealthandsuicideprevention services. c. Designandsponsorwidedisseminationofmediamessagesaboutsuicideprevention. b. Create messagesthat encourageindividualsto take steps towards preventing suicide. a. Provide technical assistancefor suicideprevention educationdirected atat-riskgroups. in themselves andknow andothers how to findhelp. ofcountyresidentswhocanrecognizesuicidewarningObjective 2:Increasetheproportion signs inawareness andenlistparticipation andpreventionc. Gaincommunitysupport activities. b. Keep thecommunityinformed aboutpublichealth suicideprevention efforts. communitysurveys, focus groups andforums. a. Determine communityneedsrelated to mentalhealthandsubstanceabusethrough • • • • • Suicide –asignificantpublichealthproblem Appendix A 1/24/2011 4 3 2 1 Michigan Department ofCommunity Health(MDCH)Divisionfor VitalRecords Department Michigan andHealthStatistics Updated YouthMichigan RiskBehavior Survey: ViolenceandSuicideFact Sheet 2009 New HampshireSuicidePrevention 2010 PlanJanuary Centers for DiseaseControl andPrevention (CDC)SuicideDataSheet Summer2010 victims andthosewhomay feel they failedto prevent thedeath. Many are affected inavariety others ofways, includingthoseproviding emergencycareto the For suicidedeath,familyandclosefriendsareathigherriskfor each suicidethemselves. Females attempt suicidetwo to asmales. threetimesasoften Male suicidedeathsoutnumberfemale deathsby about4to 1. 15 to 24 intheUS. Suicide isthethirdleadingcauseofdeath,accountingfor ofalldeathsfor thoseages 12.2% Table Source: Youth Michigan Risk Behavior Survey: Violenceand SuicideFact Sheet 2009 1 1 2 15 Introduction 16 Introduction Source: New HampshireSuicidePrevention Plan Table Source: MDCHDivisionfor VitalRecords andHealthStatistics Poster Campaign Reduce thestigmaassociated withobtainingmentalhealthandsuicideprevention services. Promote awareness thatsuicideisapublichealthproblem thatisgenerallypreventable. specifically: These posters addressthegoalsoutlinedinOaklandCountyYouth SuicidePrevention Plan, Messages includedthenumberto CommonGround’s 24-hour suicidehelpline. • • Messages depicted are: Posters were developed withmessagesdesignedto encouragehelp-seekingbehavior. • • • Drugs andalcoholcanleadto thoughtsofsuicide.Talk to someoneyou trust. Depression canleadto thoughtsofsuicide.Talk to someoneyou trust. • • takingresponsibility for their overall aspersons health. oftheseservices consumers components ofoveralland inseparable health,andthatrespond to specifictreatments and asrealillnesses,equal ofthepublicthatviews mentaldisorders Increase theproportion • • andknowthemselves how andothers to findhelp. ofcountyresidentswhocan recognizesuicidewarning signsin Increase theproportion preventablerecognize suicideasagenerally publichealthproblem. consumerandclientgroupsthat Increase thenumberofcommunities,organizations, addressing suicideopenlycanreduce risk andprevent suicidalbehaviors. Educate with mentalillnessandtheir thepublicthattheiracceptanceofpersons treatments for mentaldisorders. Disseminate information to thepublicdemonstratingthatthereareeffective Design andsponsorwidedisseminationofmediamessagesaboutsuicideprevention. Create messagesthatencourageindividualsto take steps towards preventing suicide. 17 Introduction Depression can lead to thoughts of suicide

Talk to someone you trust

Need advice? Call the Helpline 800.231.1127 or Live Chat commongroundhelps.org

Oakland County Youth Suicide Prevention Task Force

helping people move from crisis to hope Drugs and alcohol can lead to thoughts of suicide

Talk to someone you trust

Need advice? Call the Helpline 800.231.1127 or Live Chat commongroundhelps.org

Oakland County Youth Suicide Prevention Task Force

helping people move from crisis to hope School Prevention Plan

What Schools Can Do to Prevent Suicide...23

Checklist of Current Suicide Prevention Activities...25

Steps For Getting Started...27

School Prevention Plan Worksheet...29

School Staff Assignments...31

Developing Protocols to Help Students at Risk for Suicide...33

Developed by the Oakland County Youth Suicide Prevention Task Force Talk to Someone You Trust Develop protocols for respondingto suicidedeath,including: Screenstudents: Studenteducation: Parent education: Train whointeract withstudents: allstaff Develop andimplementprotocols regardingsuicide: academic achievement andhealthy behaviors amongstudents. climate—increasing students’senseofconnectedness to theschool—can resultinimproved their learningaswell asaboutthemindividuals.Making positive changesto theschool School connectedness isthebeliefby intheschoolcareabout studentsthatadultsandpeers • Secure agreements with community partners, suchasCommonGround, to helpinthe Secureagreementswithcommunitypartners, • responsiblefor takingthesesteps Outlinestaff • Determine thesteps to take thesuicideofastudentorothermember oftheschool after • for andcommunitymentalhealthprovider screening support Engageparent,staff, • Implementasuicidescreeningprogram • Integrate suicideprevention into otherstudentbehavioral healthinitiatives • oneormoreprograms to Offer engagestudentsinsuicideprevention efforts • Engageparentsinsuicideprevention strategies • Provide information aboutsuicideandrelated behavioral healthissues • Follow schoolprotocols related to suicideprevention • Designagreementswithcommunityproviders to provide to behavioral healthservices • Respond to studentswhoattempt suicideatschool • Refer andfollow upwithstudentsidenti • Recognize andrespondto students whomay beatriskofsuicide • event ofasuicide community students What SchoolsCanDoTo Prevent Suicide fi ed asatriskofsuicide 23 School Prevention Plan are includedinthistoolkit. related to helpingasuicidalstudent.Resources to assistyour schoolwitheachofthesecomponents This checklistwillassessthecompleteness ofyour school’ssuicideprevention planandyour policies program Implemented asuicidescreening Screening to engage studentsinsuicideprevention Implemented atleastonetypeofprogram Student Education issues. about suicideandrelated mentalhealth Parents ofourstudentsareeducated Parent Education risk ofsuicide. appropriately to studentswhomay beat are trainedto recognizeandrespond staff All professional andsupport school-based suicideprevention efforts. of information abouttheimportance received staff All professional andsupport EducationandTrainingStaff may beatriskofsuicideisinplace. Written protocol for helpingstudentswho SuicidePrevention Activities of Suicide Protocols for HelpingStudentsatRisk initiatives. and other health/mentalhealthcourses Suicide prevention isintegrated into identi refer, andfollow upwithstudents aretrainedto assess, Select schoolstaff in place. students whoattempt suicideatschoolis Written protocol for respondingto fi ed asatriskofsuicide. . Suicide Prevention Activities Checklist ofCurrent .

Yes ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐

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No ☐ ☐

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IfNoorNotSure Suicide- page33 to HelpStudentsatRiskof See Developing Protocols Suicide- page33 to HelpStudentsatRiskof See Developing Protocols for Schools-page37 Suicide Prevention Programs See Evidence-Based call 1-800-231-1127 you develop thismaterial- Common Ground canhelp Programs- page37 Suicide Prevention See Evidence-Based page 53 Prevention TipSheet- See Parent Suicide Recruitment Letter, page49 CrisisTeamSee Staff Respond- page57 Suicide andHow to See Warning Signsfor page 7 Prevention for Schools- See Introduction to Suicide 25 School Prevention Plan Step 2.Bringpeopletogether theplanningprocess. to start Engageadministrators, schoolboards,andotherkeyStep 1. players. out several atthesametime. These steps orderorcarry arenotnecessarilysequential.Considercompleting theminadifferent start. out to thecommunity. from Otherschoolsmay the involve andcommunitypartners bothstaff schools may want by to and thenreach convening members start agroup composedofstaff Having therightpeopleinroom isessentialto any successfulplanningprocess. Some sensitive natureofthisissueor becauseofcompeting demands. maySchool leaders bereluctantto asuicideprevention undertake initiative becauseofthe are alsocrucialfor success. out withinaschool.Otherkey players, includingsuperintendents andschoolboardmembers, ofschooladministrators, especiallyprincipals,isessentialtoThe support any activitycarried ContactCommon Ground assoonyou get Alsoreachoutto started. from ethnic leaders • to suchasaschoolcounseloror withmentalhealthexpertise, have Itisimportant staff • Shareplans.Emphasizetheuseofmany existing suicideprevention programs • Highlightdataandinformation speci • to Explainwhy addresssuicideriskamongstudents. itisimportant • communities. are culturallycompetent inreachingthestudentsandparentsfrom andeffective these and culturalcommunitiesrepresented intheschool.Thisiscriticalto ensurethatefforts social worker, involved inplanningand/orleadingsuicideprevention activities. activities alreadyinplaceattheschool. considered to bebestpractices,andthatthesestrategies canbeeasilyintegrated into the Steps For Getting Started fi c to your district.

27 School Prevention Plan 28 School Prevention Plan Step 4.Develop anoverall strategy. prevention. Usetheseresourcesfrom thistoolkit: Step 3.Provide key players withbasicinformation aboutyouth suicideand could facilitate, obstruct,or otherwise affect theprogram. affect could facilitate, obstruct,orotherwise to howAssess theschool’scurrentpoliciesandprograms. these understand Itisimportant • • • • Considerhow to addressobstacles.For example, somepeoplemightquestionwhether • culturesrepresented Learnhow different amongstudentsinyour school address • Inventory thesuicideprevention programs inthedistrictandcommunity. • Assessthehealthandbehavioral healthprograms alreadyinplacethatcouldbeenhanced • Determine whether therearepoliciesinthedistrictto whichactivitiesmustconform, e.g., •

EEmerging Issues-page63 RRisk Factors &Protective Factors- page59 WWarning Signsfor SuicideandHow to Respond- page57 IIntroduction to SuicidePrevention for Schools-page7 schools shouldbeinvolved insuicideprevention. developing your strategy. Takebehavioral healthissuesandsuiciderisk. practicesinto considerationwhen alcohol andotherdrugs. connectedness; improve theschoolclimate; orprevent bullying,violence,or theabuseof with suicideprevention activities.Theseprograms includethosedesignedto build trainingfor students,orprotocolstraining for staff, for suicideprevention or intervention. n m i t a s r k r e o n

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______factors, warning signsandresources: Information andresourcematerial distributionfor parents, whichincludesadescriptionofrisk ______suicide prevention andavailable to identify, andrefer intervene suicidalyouth: (schoolcounselor,Names ofschoolpersonnel socialworker, psychologist) speci ______education: Staff ______Ideas to adaptprovided protocols: intervention ______Procedure for trainingnew hires: ______Frequency oftraining: School SuicidePrevention PlanWorksheet fi cally trainedin 29 School Prevention Plan 30 School Prevention Plan ______resources relatedOther organizationsthat offer to suicide: ______withOaklandCountyHealthDivisionOf Agreement/Contact ______withOaklandCountyCommunityMentalHealthAuthority: Agreement/Contact ______withCommonGround: Agreement/Contact ______Plan for studentscreening: ______Plan for continuedsuicideprevention educationfor students: fi ce ofSubstanceAbuseServices: and implementingcomponentsofaschool’ssuicideprevention program: may beinvolved inseveral ofthecomponents.Thefollowing peoplemay behelpfulinplanning willimplementthesteps areasofexpertise invarious withdiffering chapters. ManyStaff staff representing theactivitiesinwhichthey willbeinvolved. and implementingeachcomponentofyour suicideprevention program. Checkthecolumn onthenext pagetoUse thechart recordthenamesofpeoplewhowillplay arole inplanning • Student Assistance Program staff/ StudentAssistanceProgram staff/ • SchoolSocialWorker • GuidanceCounselor/SchoolCounselor • SchoolHealthCoordinator • • School Nurse • Health Educator • Curriculum Director • Assistant Principal • Principal • School Board • Superintendent Pupil Services Coordinator Pupil Services School Staff Assignments School Staff

• Teacher Aids SchoolBusDrivers • • Athletic staff • Technology staff • Teachers SchoolResource Of • SchoolSecurityOf • ChildStudyTeam member(s) • School-basedhealthcenter and/or • • School Psychologist oftheCrisisResponse Members Team • SpecialEducationstaff • mental health center staff mental healthcenter staff fi cer fi cer 31 School Prevention Plan 32 School Prevention Plan

Check the box for each component(s) that each staff person will plan and implement.

Name and Title Writing Agreements Crisis Protocols Staff Parent Student Student Your School’s with Community Response for Helping Education Education Education Screening Prevention Plan Organizations Team Students at and Training Coordinator Risk ☐ ☐☐ ☐☐☐☐☐ ☐ ☐☐ ☐ ☐☐☐☐ ☐ ☐ ☐ ☐ ☐☐☐☐ ☐ ☐ ☐ ☐ ☐☐☐☐ ☐ ☐ ☐ ☐ ☐☐☐☐ ☐ ☐ ☐ ☐ ☐☐☐☐ ☐ ☐ ☐ ☐ ☐☐☐☐ ☐ ☐ ☐ ☐ ☐☐☐☐ ☐ ☐ ☐ ☐ ☐☐☐☐ ☐ ☐ ☐ ☐ ☐☐☐☐ ☐ ☐ ☐☐ ☐☐☐☐ ☐ ☐ ☐ ☐ ☐☐☐☐ ☐ ☐ ☐ ☐ ☐☐☐☐ ☐ ☐ ☐ ☐ ☐☐☐☐ to helpyou develop properprotocols forsuicideprevention. be referred to. Involve providers indeveloping theseservice protocols. for providers these schoolsto studentscan suicide. Itisimportant identifymentalhealthservice Many schoolscannotdirectlyprovide for appropriate studentsatriskof mentalhealthservices Step 3:Identifyandinvolve providers to refer mentalhealthservice students. Inform theschoolcommunitythatany concernsneedimmediate actionby notifyingaschool • know thesuicideriskresponsecoordinator Ensureallstaff andthealternate. Keep thelistof • Designate atleastoneindividual andonealternate to asthepointsofcontactfor anyone serve • is aconcern.Theplanninggroup shouldtake thefollowing steps: Everyone intheschoolmusttake suicidalbehavior seriouslyandshouldknow whoto askifthere Step 2:IdentifyaCrisisResponse Team coordinator. with thatprocess. familiar the schoolalreadyhasaprocess for identifyingstudentsatriskofsuicide,includestaff administrators, resourceof socialworkers andpsychologists.including schoolcounselors, Thegroup shouldalsoinclude thatwould normallybeinvolvedThis group shouldincludestaff inthecareofat-riskstudents, Step 1:Convene agroup to create protocols for helpingstudentsatriskofsuicide. • Spiritual leaders or traditional healers to ofsome culturesmay ortraditional healers whichmembers turn when Spiritualleaders • careproviders Primary • providers, includingpsychiatrists, psychologists Mentalhealthservice andsocialworkers • Communitymental healthcenters • • Psychiatric hospitals andpsychiatric units Hospitals,especially emergencydepartments • should stay withthestudentuntilsuicideriskresponsecoordinator arrives. administrator whowilllocate thesuicideriskresponsecoordinator oralternate. person Astaff contacts updated. concerned thatastudentmay beatrisk. confronted withbehavioral healthissues to HelpStudentsatRiskfor Suicide fi cers, teachers, andamemberoftheschoolCrisisResponsecers, Team. If Developing Protocols Others mayOthers include: Common Groundiswilling 33 School Prevention Plan 34 School Prevention Plan providers. planshouldbedevelopedthis process. through Areentry consensusofthefamily, school,and of schoolandwilloversee thestudent’sreentry. Parents step shouldbeengagedinevery of whilethestudentisout clinicians, andschoolstaff point ofcontactfor parents,hospitalstaff, assigned to facilitate thestudent’sreturn memberwillbetheprimary to theschool.Thisstaff membersuchasateacher,A staff counselor, socialworker orschoolpsychologist shouldbe of returning to oftheir attempt school,duringany orcrisis. schoolcrisis,orneartheanniversary andmonitoring,strain. They especially duringthe needconsiderablesupport school campus. Step 5:Develop aprotocol for respondingto asuicideattempt intheschooloron Documentingtheprocess • Referring provider to amentalhealthservice • • Notifying parents Assessingsuiciderisk • should includeprovisions for thefollowing: shouldbeaware oftheprotocolof suicide.Allstaff andfollow itwhenappropriate. Theprotocol It iscriticalto have aprotocol inplacefor helpingstudentsidenti onpage45. ProtocolSuicide Intervention for Staff Chart Step 4:Develop aprotocol to helpstudentsatriskfor suicide.Seethesample for aspeci should berevisited year. every to determine Itisimportant whether memberresponsible any staff they may becalleduponto inimplementing theprocedures outlined.These protocols participate needto members befamiliarwiththeprotocolsAll staff for helpingstudentsatriskofsuicide; Step 7: theprotocols. understand Helpstaff These problems cancreate additionalstressfor studentsalready undersigni academics. and teachers, have problems catchingup,and betakingmedicationsthatinterfere withtheir Returning to schoolcanbedif Step 6:Planfor managingastudent’sreturn to school. incidents dooccur. Schoolsneedto bepreparedfor suchanevent. Although studentsinfrequentlyattempt suicideinschoolsoronahighschool campus,such fi c activity has left the school and all new staff becomefamiliar withtheseprocedures. theschooland allnew staff c activityhasleft fi cult. Students may worry about the reactions of their peers aboutthereactionsoftheirpeers cult. Studentsmay worry fi ed asbeingatpotential risk fi fi cant emotional rst severalrst months Student Education

Evidence-Based Suicide Prevention Programs for Schools...37

Teaching Adaptive Skills to Students...39

Developed by the Oakland County Youth Suicide Prevention Task Force Talk to Someone You Trust (651) 213-4484 [email protected] To schedule: Help-seekingismodeled • Promotes acaring, • • Comprehensive, Lifelines (425) 861-1177 reconnectingyouth.com To schedule: Life-skills trainingand • Training) CAST (Coping&Support (866) 833-6727 edu [email protected]. To schedule: Assistsintheearly • • Identi TeenScreen community competent school prevention program schoolwide suicide of 6-8students ingroups social support be identi that mightnototherwise identi of mentalhealthservices rga ecito gsIpeetto eghCost Length Implementation Ages Program Description fi fi cation ofproblems es youth inneed School SuicidePrevention Programs fi ed Middle Middle School School School School School High High High Withinthe regular • Workshop for parents • Training for facultyand • • Establishment of Review ofresources • Applyskillsand • Focus ongroup • asafollow-up Serves • Groups ledby trained • Ifsymptoms warrant • Ifriskisindicated, • • 10-minute • Others • Others receive health curriculum staff procedures administrative trusted adults from increase support and depression management ofanger making skills, self-esteem, decision goalsetting, support, for suicide being atsigni been identi for youth whohave ornurses counselors, high schoolteachers, noti referral, parentsare professional on-site mentalhealth student meets withan questionnaire concerns stigma andexpress any debrie services assistance fi ed and offered ed andoffered fi ng to reduce fi fi nding ed as fi cant risk 55-minute sessions minutes student weeks over 6 Varies per 12 10 10 $425 $250 Free counselors counselors counselors Teachers, T Staf 3 school eachers, eachers, In Kind Costs fi ng/ 37 Student Education 38 Student Education Adapted From Suicide Prevention Resource Center’s andSAMHSA BestPractices Registry Trains studentsaspeer • Buildsprotective in • Sources ofStrength (781) 239-0071 org sosinfo@mentalhealthscreening. To schedule: (701) 471-7186 [email protected] To schedule: (425) 861-1177 [email protected] To schedule: Schoolcrisisresponseplan • Schoolbondingactivitiesto • Control earlysignsof • • Build resiliency Skills Group Approach to BuildingLife Reconnecting Youth: aPeer Teaches students how to • SOS SignsofSuicide and inthecommunity atschool with adultadvisors andconnectsthem leaders to reducesuicide activities and increasesafe, healthy improve teens’ relationships emotional distress substance useand themselves andfriends depression andsuicidein identify thesymptoms of Program Description fl uences Middle Middle School School School School School Ages High High High • Students do • Advisors facilitate • Certi • Curriculum is • S • Increase help- • Guided classroom • Taught • Recognize signs • Students are Implementation posters, PSAs messaging, media presentations, meetings training provide initial leaders nominate peer Youth Reconnecting partner agency partner or school staff taught by a seeking behavior discussions response appropriate suicide of depressionand referred for help suicide riskand depression and screened for taff /students taff fi ed trainers Leader, semester months Length as$375 2 days 3-6 1 $2,500- $4,000 $300 Cost counselors T Staf eachers, eachers, In Kind Costs None None fi ng/ Collaborative for Academic, Social, • • Resolving Con Programs thatutilizesocialskillstraining: Training programs focusing onthese skillsets have beenshown to reduce: classes suchasahealth,driver’s education,physical education,orreading. They canbetaughtdirectlythrough lessonsorindirectlyby incorporatingtheseskillsinto existing to promoteThese skillsarenecessary thedevelopment ofawell-balanced andproductive adult. It iscriticalthatsuicideprevention curriculumfocus onhelpingstudentsdevelop: adolescents from suicide.Riskfactors for suicideintheseadolescentswere signi Programs focused onskilltrainingstrategies increasedorenhancedfactors thatprotect www.casel.org (CASEL) Learning Emotional and www.promisingpractices.net andmiddleschool elementary Deathby suicide • • Attempted • Violence • Unintentional injuries • Bullying • Substance use • Hopelessness • Depression • Con • Problem-solving strategies • Help-seeking skills • Coping skills • Social skills Teaching Adaptive Skillsto Students fl ict resolutionstrategies fl ict Creatively Program (RCCP)- fi cantly reduced. 39 Student Education 40 Student Education toll-free at isalsoavailableSupport 24/7 through abullyinghotline,operated by CommonGround, Contact exposurelifelong to effects bullyingcanhave onanindividual’swell-being. bullying isandthetragediesthatcanoccursecondarily. apparentarethe Whatarenotoften religion andsocioeconomicstatus.Mediahas onlyheightened ourawareness ofhow common anyoneBullying knows noboundaries-itcanaffect independentofgender, age,race,ethnicity, teachers, andhealthcareproviders to helpaddressbullyingandits impact. problems. Active areasofprogram development explore innovative ways families, to partner exposed to bullying,recognizingthatvictims,witnesses,andbulliesareallatriskfor lifelong bullied childrenandfamiliesaffected by bullying.Itfocuses onmeeting theneedsofallyouth A Beaumont-basedprogram providing integrated to support educational andcounselingservices No BullyingLive Empowered (NoBLE)Program ormiddleschools: Providers inOaklandCountyelementary LST promotes healthy alternatives to riskybehavior through activitiesdesignedto: Abuse Prevention. government ofEducationandtheCenter for agencies,including theU.S.Department Substance Botvin LifeSkills Training program by isrecognizedasaModelorExemplary anarray of adolescents thecon This program reducestherisksofalcohol,tobacco, drugabuse,andviolenceby providing Botvin LifeSkills Training (LST) • Student Leadership Services- Dawn Flood-(248) Services- StudentLeadership 706-0757 • OaklandCountyHealthDivision-AngelaGullekson-(248) 858-9598 • HollyAreaYouth Coalition-SusanPapple- (248) 328-3135 • LuzTelleria- CSSHispanicOutreachServices- (248) 338-4250x3703 • ArabAmericanChaldeanCouncil-ShaneenJones-(248) 559-0960 • Enhancecognitive andbehavioral competency to reduceandprevent healthriskbehaviors • Increasetheirknowledge oftheimmediate consequencesofsubstanceuse • Enablestudentsto copewithanxiety effectively • Helpstudentsto develop greater self-esteem andself-con • Teach skillsto resistpeerpressuresto studentsthenecessary andusedrugs smoke, drink, • NoBLE

855-UR-NOBLE 855-UR-NOBLE at 248-898-9951 fi dence and skills necessary to successfullyhandlechallengingsituations. dence andskillsnecessary (855-876-6253). to learnmoreabout how they canhelp. fi dence Resources

Talking Points for Staff...43

Suicide Intervention Protocol Chart for Staff...45

Crisis Lines and Other Resources...47

Staff Crisis Team Recruitment Letter...49

Parent Crisis Team Recruitment Letter...50

Parent Education...51

Parent Suicide Prevention Tip Sheet...53

Developed by the Oakland County Youth Suicide Prevention Task Force Talk to Someone You Trust counseling, information andreferrals. What you cansay thathelps: Questions you canask: Here areways aconversation to aboutsuicide start Speak upifyou’re worried! than 40,000individuals peryear. arefreeofcharge. Themajorityofservices homeless youths. Helpingpeopleinneed for more morethan40years, CommonGround serves to copewith criticalsituationsandrunaway withmentalillness, peopletrying persons and Common Ground provides alifeline for individuals andfamiliesincrisis,victimsofcrime, Contact CommonGround’s 24-hour Helplineat1-800-231-1127 for freeandcon Refer:               Have you thoughtaboutgetting helpandtalkingto someone? youHow rightnow? canIbestsupport Did something feeling happenthat madeyou thisway? start When didyou beginfeeling like this? I wanted to checkinwith you becauseyou haven’t seemedlike yourself lately. Recently, Ihave inyou noticedsomedifferences andwondered how you aredoing. I have beenfeeling concernedaboutyou lately. Let’s callyour parentstogether, rightnow. Let’s callCommonGround rightnow; we cancallthemtogether. You to deserve speakto someonewhoisquali When you want to give up,tell for yourself you justonemoreday. willholdoff help. I may notbeableto exactly understand how you feel, butIcareaboutyou andwant to You may notbelieve itnow, buttheway you’re feeling willchange. You arenotaloneinthis.I’mherefor you. Talking Points For Staff fi ed to helpyou. : fi dential 43 Resources 44 Resources • Don’t offer ways Don’toffer to • Don’tpromise con • Don’tactshocked, lectureonthevalue oflife, or • Avoid Don’targuewiththesuicidalperson. saying • Avoid thesecommonnegative reactions: says Bedirect.Iftheperson thingslike, “I’msodepressed,Ican’tgoon,”askthequestion: • hope.Reassure thestudentthathelpisavailable Offer andthatthesuicidalfeelings are • Besympathetic, non-judgmental,patient,calm,accepting.Thestudentisdoingtheright • Listen. Let thesuicidalstudentunloaddespair, ventilate anger. Nomatter how negative the • Beyourself. Let thestudentknow you care,thathe/sheisnotalone.Therightwords are • ContactCommonGround orrefer studentfor professional helpat1-800-231-1127. • Tips to keep in mind: problem is, but how badly it’s hurting yourproblem is,buthow student. badly it’s hurting their suicidalfeelings. Itisnotabouthow badthe advice, ormake themfeel like they have to justify your word. keep discussionssecret, you may have to break keep safe. Ifyou thesuicidalperson promise to speak to amentalhealthprofessional inorderto to secrecy. Alife isatstake andyou may needto say thatsuicideiswrong. side.” your family,”suicide willhurt or“Lookonthebright things like: “You have somuchto live for,” “Your share theirpainwithyou. showing thatyou areconcerned,thatyou take themseriously, andthatit’sOKfor themto “Are you having thoughtsofsuicide?”You arenotputtingideasintheirhead;you are temporary. Let to thestudentknow thathisorherlife you. isimportant thing by talkingabouthis/herfeelings. conversation seems,thefactthatitexists isapositive sign. Ifyou areconcerned,your unimportant. often voice andmannerwillshow it. fi dentiality. Refuse to besworn fi x theirproblems, orgive Protocol Chart for Staff

Student has displayed one or more suicide warning signs

Notify the principal/building administrator/designee No attempt Attempt

On site Off site

No plan, Self-harm, threat, ideation, If a weapon is Clear the area of other students, no intention plan, attempt history present, clear the DO NOT LEAVE to harm self OR UNSURE area and call 911 STUDENT ALONE, DO NOT LEAVE or local police Render or request fi rst aid STUDENT ALONE

Life threatening?

Yes No Refer to Talking Consult with school crisis team, Points Notify parents or guardians, Follow crisis recommendations Call 911 & parents/ CCallall pparentsarents iimmediately,mmediately, guardians rreferefer ttoo CCommonommon GGroundround 11-800-231-1127-800-231-1127

Disposition determined after Encourage student to Document actions taken crisis assessment seek help: parents, as recommended by your school guidance school’s written procedures, counselor, Common Debrief with staff, Monitor other at-risk students, Ground Follow up with parents/ 11-800-231-1127-800-231-1127 provide support on the same day guardians of the incident Contact parents if student is away from school to set up reentry meeting Adapted from Main Youth Suicide Prevention Program

DDevelopedeveloped byby thethe OaklandOakland CCountyounty YYouthouth SSuicideuicide PPreventionrevention TTaskask FForceorce // Talk to Someone You Trust Additional Resources: Common Ground: Crisis LinesandOtherResources www.occmha.org 1-800-341-2003 Oakland CountyCommunityMentalHealthAuthority commongroundhelps.org Crisis ChatLine 248-292-0194 Teen to Teen 1-800-231-1127 Helpline 1-800-273-TALK (8255) National Crisi s Line www.oakgov.com/health/osas/sas_about.htm 248-292-0194 Of Oakland CountyHealthDivision fi ce ofSubstanceAbuseServices Developed by theOaklandCounty Youth SuicidePrevention Task Force Talk to Someone You Trust 47 Resources 48 Resources coordinating studentsuicideprevention educationorrespondingto asuicidecrisis. in. Examples includeleadingsuicideprevention directingparentvolunteers, trainingsfor allstaff, Your schoolshoulddecidewhatactivities,ifany, you would like crisisteam your to staff participate Ground trainingat1-800-231-1127. for information aboutstaff AidorASISTtraining.ContactCommon inaMentalHealthFirst Thismay includeparticipating staff. intrainingbeyond shouldparticipate members thebasic suicidepreventionThese staff trainingfor all Schools canusethisletter CrisisTeam. volunteers to to oftheSchool’sStaff recruitstaff bemembers Sincerely, please contactmeby ______. If you areinterested orhave morequestionsregarding thedevelopment ofacrisis team, team coordination. onateam,well withothers andwould bewillingto spendtimeto meet for trainingand dealing withcrisissituations,knowledgeable aboutcommunityresources,ableto work developed. We who arecomfortable arelookingfor crisisteam andmembers leaders aschoolcrisisteam ofourschool’ssuicideprevention isbeing As apart planningefforts, Dear Staff: Developed by theOaklandCounty Youth SuicidePrevention Task Force Staff CrisisTeamStaff Recruitment Letter Talk to Someone You Trust 49 Resources 50 Resources County HealthDivisionOf including CommonGround, OaklandCountyCommunityMentalHealthAuthority andOakland warning signs.Training shouldincludeanoverview ofcommunityresourcesfor suicideprevention, Parents shouldbetrainedinsuicideprevention, includingriskfactors, protective factors and Crisis Team. Schools canusethisletter to recruitparentvolunteers to oftheSchool’sParent bemembers participate in. Examples include fund-raisers, specialevents in.Examplesparticipate includefund-raisers, orstudent activities. Your schoolshoulddecidewhatactivities,ifany, you would like your parentcrisisteam to dif This information willhelpusallbemoreaware ofindividuals whomay behaving Place: Time: Date: Parent/Guardian volunteer training willoccur: provide volunteers withinformation aboutreferral andgetting astudentappropriate help. Sincerely, Thank you opportunity. for consideringthisimportant community. toteach identifysignsthatmay parentsandstaff signalemotionaldif andinterestedincludes trainingfor to staff parentsorguardians.Thetrainingserves Our schoolhasmadeacommitmentto school-basedsuicideprevention education, which Dear Parents: fi culties, whoto contactifwe areconcernedandwhatresourcesavailable to the Parent CrisisTeam Recruitment Letter Developed by theOaklandCounty Youth SuicidePrevention Task Force fi ce ofSubstanceAbuseServices. Talk to Someone You Trust fi culty. Itwillalso Knowing whereto turnfor help • thewarning signs,riskfactors Understanding andprotective factors for suicide • andinvolved Maintainingasupportive relationshipwiththeir child • Parents canhelpprotect theirchildrenfrom suicideriskby: Whereto turnfor helpinthecommunity • How to respondwhenthey recognizetheirchildoranotheryouth isatrisk • Thewarning signsofsuicide,riskfactors andprotective factors • Theprevalence ofsuicideandattempts amongyouth • it couldhappento theirchildorincommunity. Parents needto know: Although parentsmay beaware thatchildrendieby suicide,they donotthink often educate parentsaboutsuicideandgive themresourcesto helptheirchild. events andsuicidalbehaviorsare crucialto astudent’ssuicideriskassessment.It’simperative to Information from parentsregardingmentalhealthhistory, familydynamics,recenttraumatic page 53to provide to parents. Please seetheParent SuicidePrevention TipSheet on Presentingsuicideprevention educationataPTO meeting • Includingsuicideprevention inparentingclasses • offreshmanorientation, Includingsuicide awareness aspart • Sendingmaterial to middleandhigh theparentsofevery • Sponsoringevents or12th for theparents of8thgraders • Holdingaparents’nightaboutstudentsafety thatincludedsuicide prevention • a speci Schools canincludesuicideprevention activitiesinscheduledevents orschedule prevention outreachactivitiesby: safety days, orother healthevents attheschool school studentdescribinghow to helpachildincrisis substance use,andbullying,inadditionto suicide and addressingissuessuchasanxiety, depression, thatfocused ontheirchildren’supcomingtransition graders fi c event to promote healthandwellness. Schoolshave integrated suicide Parent Education 51 Resources Ifyour c • Educate your child abouttheconsequencesofsexting-- sendingexplicit imagesormessages. • Watch your childfollowing a romantic breakup orothertraumaticevent. Teens areimpulsive • Victimsofbullyingareatincreasedriskfor depressionandissuesrelated to any suicide.Report • Mostadolescentsuicideattempts involve interpersonal • Usingalcoholandotherdrugs--includingprescriptions-- • 12-17 %ofpeoplewillexperience amajordepressive • Theissuesofmentalillness,substanceuseandsuicide • feelings continuefor longperiodsoftime,itcanleadto thoughtsofsuicideorselfharm. self-doubt, lonelinessanddepression.Itisnormalfor youth to feel thisway attimes,butwhenthese Teen years canbestressfulandemotional.Thestruggleto • Dif Drugandalcoholuse • Persistent sad,anxiousoremptyfeelings • • Decreased energy Violentorrebellious behavior • Withdrawal from friends,familyandregularactivities • Changeineating andsleepinghabits • Frequent complaintsaboutnotfeeling good:headaches, • Warning signsfor suicide: • Dif • Neglect of personal appearance Neglect ofpersonal • school counselors immediately.school counselors depressed, usingsubstancesortalkingaboutsuicide,t and may notthinkthrough theconsequencesoftheirbehavior before acting. issues ofbullyingatschooloronlineto parents/guardians,teachers andschoolcounselors. romantic breakups orsexting, canplay arole. con problems. associated withdepression,traumaticevents orother can beanattempt to self-medicate to easethepain episode intheirlifetime. are closelyrelated. stomachaches orfatigue fi fi culty rememberingdetails culty makingdecisions fl icts. Long-term con hild no Parent SuicidePrevention TipSheet Developed by theOaklandCounty Youth SuicidePrevention Task Force tices apostonsocialmediasite thatindicates another studentisfeeling fl icts such as bullying or abuse and short-term con icts suchasbullyingorabuseandshort-term Talk to Someone You Trust ell parents/guardians, teachers and ell parents/guardians,teachers fi t incanleadto issueswithself-esteem, Ifyou asexual forward picture • Never take imagesofyourself • Sexting Information for Teens to register asasex offender. pornography, goto jailandhave could bechargedwithchild you of someoneunder18, employers. teachers, family orfuture everyone to see—classmates, that you wouldn’t want fl icts, including 53 Resources 54 Resources Questions you canask: Iwanted to checkinwithyou becauseyou haven’t seemedlike yourself lately. • Lately inyou I’ve noticedsomedifferences andwondered how you’re doing. • Ihave beenfeeling concernedaboutyou lately. • Here aresomeways aconversation to aboutsuicide: start Your childistalkingorwritingaboutdeathsuicide. • Your childhasaplanaboutwherethey canget thingsto with. killhimselforherself • Your childislookingfor away outasuicideplan. to carry • Your childmakes athreatto killthemselves by saying thingslike: • Take immediate actionandcallCommonGround if: • Oakland County Health Division Nurse onCall: Oakland County Health Division Nurse • Oakland CountyYouth SuicidePrevention Task Force: • Common Ground’s 24-Hour Helpline: • Any deliberate self-harmingbehaviorsshouldbeconsidered seriousandinneedoffurther • Know or early evening thatmostsuicides occurintheafternoon intheteen’s home. • Promote skillsinsolvingproblems andresolvingcon • Don’tkeep medicationswhereyour kidsor • Donotallow accessto • Encouragepositive relationshipswithmedical • Get medicalcarefor depression,substance • How canyou protect your teen? Whenyou want to give up,tell yourself you will • Imay notbeableto exactly understand how • You may notbelieve itnow, buttheway you’re • You arenotaloneinthis.I’mherefor you. • What to say thatcanhelpanat-riskteen: Have you thoughtaboutgetting helpandtalkingto someone? • you How rightnow? canIbestsupport • Didsomething feeling happenthatmadeyou thisway? start • Whendidyou beginfeeling like this? • -- “ evaluation. Notalladolescentattempters may admit theirintent. their friendscanaccess.Safely discardunusedmedications. threatening items. and mentalhealthproviders. use andothermedicalissues. for justonemoreday.hold off you feel, butIlove you andwant to help. feeling willchange. I wishwere dead” or “ fi rearms andotherlife What’s thepointinliving?” 800-231-1127 800-848-5533 [email protected] Many teens say theirparentsare not • Themajorityofteens say they abuse • 3in5teens say prescription • Substanceuseisamajorriskfactor • Prescription DrugAbuseFacts fl keep teens from using drugs. Parental disapproval way isapowerful to withthem. discussing thesedangers care asmuchifthey get caught (21%). parents’ medicine (51%). They prescriptions becausethey arenotillegal attempts involved prescriptiondrugs. for suicide.96%ofdrug-related suicide or stimulants icts inanonviolent way. www.oakgov.com/health also believe parentsdon’t areeasyto get from their cabinets. painkillers painkillers Important Facts to Know About Suicide

Warning Signs for Suicide and How to Respond...57

Risk Factors...59

Protective Factors...60

Emerging Issues...63

The Implication of Culture on Suicide Prevention...67

Glossary...69

Developed by the Oakland County Youth Suicide Prevention Task Force Talk to Someone You Trust Signsofdepression • Nosenseofpurpose inlife • Noreasonfor living • Dramaticmoodchanges • Anxiety, agitation,inabilityto sleeporconstant sleep • Withdrawal from friends,familyorsociety • Increasedalcoholordruguse • Expressionsoffeeling trapped,like there’snoway out • Recklessness orriskybehavior, seeminglywithoutthinking • Rage,anger, seekingrevenge • • Hopelessness behaviors: Get professional helpifyou witness,hearorseeanyone exhibiting thefollowing isoutofcontrol Theperson • Aweapon ispresent • Asuicideattempt hasbeen made • Call 911 if: Someoneistalkingaboutdeathorsuicideintext messages,onsocialnetworking sites orinpoems/ • Someoneislookingfor away outasuicideplan to carry • Someonemakes athreatto killthemselves: • Take immediate actionandcallCommonGround at1-800-231-1127 if: Warning signsindicate someonemay beindangerofsuicide,eitherimmediately orinthenearfuture. Warning Signsfor SuicideandHow to Respond music thepointofliving” — “What’s — “If...... doesn’thappen,I’llkillmyself” — “IwishIwere dead”

57 Important Facts to Know About Suicide be usedto helpidentifysomeonewhomay bevulnerableto suicide. behavior. Someriskfactors cannotbechanged—suchasaprevious suicideattempt—but they can People affected by oneormoreoftheseriskfactors may have agreater probability ofsuicidal RiskyBehaviors Personal Characteristics Behavioral HealthIssues/Disorders increases suicide risk. increases suiciderisk. disruptive behavior problems orsubstanceuse) (especiallythecombinationofmoodand disorders Note: Thepresenceofmultiple behavioral health Risky sexual behavior • • Aggressive/violent behavior • Delinquency Alcoholordruguse • Perception ofbeingaburdento others • Perception ofselfasvery • Poor problem-solving orcopingskills • Risktaking,recklessness • • Impulsivity Low stresstolerance • Socialalienationandisolation • • Loneliness • Low self-esteem • Hopelessness • Genetic/biological vulnerability (withoutintent to Self-injury die) • Previous suicideattempts • (e.g.,anxiety Otherdisorders • Conduct/disruptive behavior disorders • Substanceuseordependence • • Depressive disorders underweight or very overweight orvery underweight disorders, personality disorders) disorders) personality disorders, (alcohol andotherdrugs) Risk Factors Adverse/Stressful Life Adverse/Stressful Circumstances Family Characteristics Environmental Factors • Interpersonal dif Exposureto stigma anddiscrimination • Access to lethal means,particularly • Limited accessto mental healthcare • Limitationsinschoolphysical • Problems inparent-childrelationship • Deathofparentorotherrelative • • Parental divorce Parental mentalhealthproblems • Family ofsuicidalbehavior history • Exposureto suicideofapeer • Chronic physical illnessordisability • Physical, sexual, orpsychological abuse • Schoolorwork problems (actualor • Bullying,eitherasvictimorperpetrator • orlegalproblems Disciplinary • overweight or physical characteristics suchas identity, raceandethnicity, disability, based onsexual orientation,gender at home and security environment, includinglackofsafety not attending schoolorwork) perceived dif boyfriend) (breaking upwithagirlfriendor fi culties in school or work, culties inschoolorwork, fi culties orlosses 59 Important Facts to Know About Suicide 60 Important Facts to Know About Suicide MentalHealthandHealthcare Providers IndividualBehaviors IndividualCharacteristics risk factors. If you noticetheabsenceoftheseprotective factors inastudent,pay extra attention to signsof ofriskfactors. to Actions byeffects enhanceprotective schoolstaff factors canprevent suicide. factors, referredIf astudentisatriskfor to suicide,certain asprotective the factors, canbuffer Ongoing medicalandmental • Access to care for effective mental, • af that Culturalandreligious beliefs • attendance Spiritualfaithor regular church • insports Participation • • Coping skills Strong problem-solving skills • Strong verbal skills • Resilience: ongoingorcontinuing • Feeling incontrol ofwhathappens • • Self-esteem • Body image • Personal hygiene • Frustration tolerance Abilityto manageemotions • • Adaptable temperament Psychological oremotional • health relationships disorders physical, andsubstanceuse Nonviolent handlingofdisputes • • Con Abilityto communicate feelings • sense ofhopeduringadversity in life well-being fi rm life anddiscouragesuicide fl ict resolution Protective Factors School Family andSocialSupport Access to Meansfor Completing Suicide Respect for theculturesofallstudents • • Academic achievement Safe environment atschool,especially • ofacloseschoolcommunity Part • Positive schoolexperiences • Family for school support • Acaringadult • Closefriendsorfamilymembers • • Family support Restricted accessto alcohol • andprescriptionmedications Restricted accessto over-the-counter • andotherjumpingsites Safety for bridges,buildings barriers • Restricted accessto • transgender youth for lesbian,gay, bisexual, and Ammunitionstored orlocked • Gunslocked orunloaded •

fi rearms in aSocialEcologicalModel Risk andProtective Factors 61 Important Facts to Know About Suicide combined withsymptoms highinthe ofdepression.Theriskfor suicideisparticularly The greatest indicator ofsuicide riskamongpeoplewithschizophreniaisactive psychotic illness resultinemergencyandinpatienttreatment. Borderline Personality Disorderandoften Recurrent suicideattempts, self-injury, andimpulsive aggressive associated actsareoften with of suicideattempts. disorder incombinationwithdepressionorbipolarisassociated withahigherlikelihood adolescents involved prescriptiondrugs. Almost 96percent ofdrug-related suicideattempts by alcohol likely to choose amorelethal means to attempt suicide. which makes young people underthein Substances impaircritical thinkingskillsandlower inhibitions, young people. Substance useisamajorriskfactor for suicidalbehavior among other problems. associatedsuffering withdepression,familydysfunction, and drugs canbeanattempt to self-medicate to ease thepainand undiagnosed mentalillness.Theuseofalcohol andother Many young peoplewhoturnto substanceshave an facts Suicide andsubstanceuse:important disorder issigni about40millionAmericansperyear. affect Anxiety Disorders Thepresenceofany anxiety Thesuiciderate for individualswithbipolardisorderisestimated to be25timeshigherthan • to 12 17 percentofindividualswillexperience amajordepressive episodewithintheirlifetime. • More than60percentofsuicidaldeathsoccuramongpeoplewithdepressionorbipolardisorder. facts Suicide andmentalhealth:important education andhighersocioeconomicstatus. years ofonset ofschizophrenia.Increasedriskfor suicideisalso associated withhigherlevels of the generalpopulation. fi cantly associated withsuicidalideationandattempts. Thepresenceofananxiety Emerging Issues fl uence ofdrugsor fi rst rst 3–5 63 Important Facts to Know About Suicide 64 Important Facts to Know About Suicide • Educating school staff, students,and Educatingschoolstaff, • students, Educatingschoolstaff, • Enhancingprotective factors, suchasconnectedness, whichcanalsoimprove theschool • Identifyingstudentsatriskfor suicide,substanceuseordepressionandensurethatthey • Substance useandsuicidecanbeaddressedwithcommonstrategies including: Implications for prevention because they arefound inthehome. Parents areinaunique positionto immediately reduceteen access to prescription drugs research shows thatparentaldisapproval way isapowerful to keep teens from using drugs. Many teens say withthem,even theirparentsarenotdiscussing thesedangers though caught (21 percent). they arenotillegal(51 The majorityofteens say they ratherthanotherdrugs because abuseprescriptionpainkillers Three in friends orrelatives, withouttheirknowledge. often 64 percentofteens whohave abusedpainrelievers orstimulantssay they gotthemfrom Prescription drugabusefacts these substances. ofrestrictingaccessto importance drugs—in adolescentsuicide,andthe and drugs—includingprescription parents abouttherole ofalcohol depression. among substanceuse,suicideand and parentsabouttherelationship environment andenhanceacademicachievement. receive help.Seethestudenteducationprograms withascreeningcomponentonpage37. fi ve teens say areeasyto prescriptionpainkillers get from parents’medicine percent

). They also believe parentsdon’tcareasmuchifthey get cabinets. • Identifying and providing services to Identifyingandproviding studentswithriskfactors services for bullying orbeingbullied • • Family outreach Prevention strategies to improve schoolclimate • Implications for prevention inearlychildhood,whichcanleadto Aggressiveness rejectionby andsocialisolation peers • • Low assertiveness • Low self-esteem Internalizing problems (includingwithdrawal, anxiety anddepression) • These arealsoriskfactors for suicide.Characteristics include: Many children whoarebulliedhave characteristics thatincreasetheirriskofvictimization. are long-term andmay into persist adulthood. ofbullying(especiallychronic bullying)onmental health Theeffects of bullyingareathighestrisk. Youth whoare are athigherriskofsuicidethantheirpeers. Both victimsandperpetrators ofbullying their peers. youth experience morebullyingatschoolthan Lesbian, gay, bisexual andtransgender(LGBT) media andtexting, to bullytheir victims. which peopleusetechnology, suchassocial Cyberbullying isanemergingproblem in by others. victimization ofaperson Bullying istheongoingphysical oremotional facts Suicide andbullying:important risk for depression and other problems associated with suicide. risk for depression andotherproblems associated withsuicide. beingbullied.V report 20-40 percentofstudents ages12–18 both victims andperpetrators

ictims of bullying are at increased ictims ofbullyingareatincreased 65 Important Facts to Know About Suicide 66 Important Facts to Know About Suicide • Report any Report nude picturesyou receive onyour cellphone to anadultyou trust.Donotdelete the • Ifyou asexual forward pictureofsomeoneunderage, you are responsible for thisimage.You • You andit’sagainst thelaw. teams, loseeducationalopportunities of sports couldget kicked off • Before hitting send,rememberyou cannotcontrol wherethisimage may travel. Whatyou send • Never take imagesofyourself thatyou wouldn’t want everyone—your classmates, your • Educate studentsabouttheconsequencesofsexting: having dif from theexperience… withtimestudentswill time to healfrom. Ifstudentslet themselves grieve, acknowledge thelossandfocus onlearning Ideally, asstudentswork through process, therecovery they will begin to feel better. Losstakes Implications for prevention breakup. Inanattempt to cope,studentsmay to reactby trying focus, changesinsleepingandeatingpatterns anddisruptionintypicalroutines following a It’scommonfor teens to experience lossofenergy, lackofmotivation ordirection,inabilityto facts Suicide andromantic relationships:important Whoareyou onyour own andhow doyou want to live your life? • Whatareyour prioritiesandpreferences inlife? • Were therepatterns orissuesthatbrought you into thisrelationship orcauseditto end? • Whatispositive? Whatwould you like to change? • Whatdidyou noticeaboutyourself intherelationship? • setting realisticgoalsorexpectations. Thesequestionsmay behelpfulto discuss: people andprofessionals). Puttingemotionsinto words helpsto clarifyexperience andassistin Sometimes itishelpfulto (family, talkthesethingsthrough withothers friends,othersupport The bestway to dealwiththeendingofarelationshipisfor studentsto let themselves grieve. the riskfor suicidefollowing aromantic breakup. potential inabilityto thinkthrough theconsequencesoftheirbehavior before actingcanincrease A romantic breakup isatraumaticevent for many teens. Theirimpulsive naturecombinedwitha numb thepainandescapesituation.Theseattempts to copefrequentlycreate deeperdespair. message. Get parents/guardians, teachers and school counselors involvedmessage. Get parents/guardians, teachers andschool counselors immediately. could facechildpornography charges,goto jailandhave to register asasex offender. to aboyfriend orgirlfriendeasilycouldendupwiththeirfriends.Whatifphone isstolen? teachers, your familyoryour employers—to see. fi culty copingwithabreakup, notifyparentsassoonpossible.

fi nd themselves moving on.Ifastudentseemsto be fi nd a“ fi x”—using substancesto The ImplicationsofCultureonSuicidePrevention a vulnerableyoung failsto person meet familyexpectations inacademicachievement. cultures promote astoicism thatmakes seeingwarning signsdif Culture in andexpressionThe understanding ofthe warning signsof suicide in schoolmate may provoke a“copycat” suicide.Thismay nothappenincultureswherefamily attempts. Inculturesinwhichpeer Culture in The precipitantsofsuicidalbehavior weaken asfamiliesbecome“Americanized” andyoung peoplegrow moreindependent. Family may beastrong support protective factor inimmigrantfamilies.Butsuchprotection can Risk andprotective factors de theculturalcontextUnderstanding ofsuicidalbehavior isessentialfor prevention. Cultureis or “LGBT.” Culturechangesover time. by categories suchas “Hispanic,”“American Indian/Alaska Native,” “disabled,”“rural,”“southern,” The culturesofgroups sharingcommonhistories and/orheritagesarenotadequately described design andimplementculturallycompetent suicideprevention activities. and“culturalmediators” or“culturalbrokers.”leaders, They canprovide insightinto how you can thecultureswithinyourUnderstanding schoolentailsworking withstudents,families,community Askfor oraccepthelp • Display emotionsordistress • Thinkaboutsuicide,death,andmentalillness • Culture profoundly in social institutionsofagroup. or demeanor. cultures may bereluctantto talkabouttheir problems; ratherthey express them through behavior fl uence isstronger thanpeerin fi ned asbeliefsystems andvalue orientationsthatin fl fl uences how peopledisplay (orrefrainfrom displaying) emotional distress.Some uences how young peoplerespondto events thatescalate riskandtriggersuicide fl uences how people: fl uence. Inthose cultures, asuicideattempt mightbetriggeredif fl uence isstrong, for example, thesuicideofafriend or fl uence customs, norms,practices,and fi cult. Young peoplefrom other 67 Important Facts to Know About Suicide 68 Important Facts to Know About Suicide competent suicideprevention andeffective messages. Working together to bringtheinsightsofbothscienceandcultureiskey to providing culturally what studentsandfamilieslearnaboutsuicide andmentalhealth,may challengetheirbeliefs. andmentalhealthproviders learnaboutthecultureofstudentsand families,and What staff Besensitive It to stigmaaround issuesofsuicide,help-seeking,andmentalhealthservices. • Tailor prevention programs to theways culturesdisplay different orconcealdistress. • Respect andbuilduponthereligiousspiritualheritageofstudents.Somefamiliesmay • inguaranteeing Engagefamiliesasactive ayoung safety, participants person’s aswell asin • thatbuildonaculture’sstrengthsandprotective Create culturallysensitive services factors. • Actively ofandrespectfor show theculturesofstudentsandtheirfamilies. anunderstanding • population Recommendations for respondingto effectively thecultures ofyour student orarefrom culturalgroups otherthantheirown.health personnel) or otherforms oftraumamay fear peoplewhorepresentauthority(includingschoolandmental Youth andfamiliesfrom groups withhistories ofvictimization,oppression, sectarianviolence, Trust self-reliance andregardany help-seeking(even withinthefamily)asaweakness. ratherthanmentalhealthprofessionals Otherculturesmayleaders orother“outsiders.” value Youngsupport. peoplefrom someculturesmay prefer to orreligious consultfamilymembers Culture plays alargerole indetermining who(ifanyone) young peopleturnto for emotional Help-seeking behaviors openly andcomprehensively. Suicideanditsprevention arecomplex andmulti-dimensionalneed to beapproached may be useful to offer services insettingsmay notassociated beusefulto withmentalhealthtreatment. services offer providers ormay to want to theirchildren. bothtypesofsupport offer before theyseek thepermissionofspiritualortraditionalleaders turnto mentalhealthservice the therapeuticprocess.

actions, customs, values, beliefs, andinstitutions ofaracial,ethnic, faith,orsocialgroup. undergone scienti (also referred ofsuicideloss). to assurvivors Gatekeepers Evidence-based programs Deliberate self-harm Culture Culturally appropriate Contagion Connectedness Comorbidity Community Best practices Bereaved by suicide Behavioral health Affected by suicide substance usedisorder. regarding whatiseffective. addiction, seriouspsychological distress,suicide,andmentalsubstanceusedisorders. wellness. Behavioral healthproblems includesubstanceuseormisuse,alcoholanddrug employed in schools. fi asappropriate. Examplesservices include clergy, suicide andrefer themto treatment orsupporting They may be trainedto atriskof identifypersons oftheirusual routine. as part community members who have face-to-face of contact withlargenumbers loved andwanted by others. bereaved by andothers. suicide,aswell ascommunitymembers individuals and families receiving services. individuals andfamiliesreceivingservices. of theprogram to language,interpersonal of styles,andbehaviors honorandrespectthebeliefs, of anorganizationorprogram thatenablesitto across beeffective cultures,includingtheability through suicidalacts. knowledge of anotherperson’s rst responders, pharmacists, caregivers, and those pharmacists,caregivers, responders, rst —The integrated pattern ofhumanbehavior thatincludesthoughts,communication, —A phenomenonwherebyarein susceptiblepersons —A group ofindividualsresidinginthesamelocalityorsharingacommoninterest. —The co-occurrence of two or more disorders, suchasdepressive—The co-occurrenceoftwo disorderand ormoredisorders, —Those individualsinacommunity —The studyofstatisticsandtrendsinhealth diseaseacross communities. —Activities orprograms thatareinkeeping withthebestavailable evidence ---perceived satisfactionwithrelationshipto caringby orfeeling others, others, —A state ofmental/emotionalbeingand/orchoicesandactionsthataffect fi c evaluation andproven effective. —All thosewhomay feel theimpactofsuicidalbehaviors, includingthose —Family affected by friends,andothers thesuicideofaloved members, one —See suicidalself-directed violence. —A set ofvalues, behaviors,attitudes,andpracticesre —Programs thathave Glossary fl uenced toward suicidalbehavior fl ected inthework 69 Important Facts to Know About Suicide 70 Important Facts to Know About Suicide however, whoidentifyastransgender. sex alignswiththeirgenderidentity. assignedto thematbirth This isnottruefor someothers, environment. factors may encompass biological,psychological, orsocial factors intheindividual, family, and behavior (e.g.,overdose). of adverse healthproblems,of adverse orreducestheharm resultingfrom conditionsorbehaviors. discrimination they experience from thedominantgroup insociety. (including lesbian,gay, bisexual, ortransgenderpopulations)asaresultoftheprejudiceand family, andenvironment. Protective factors may encompassbiological,psychological, orsocialfactors intheindividual, Risk factors Resilience Rate Protective factors Prevention Postvention Nonsuicidal self-injury Minority stress Mental health Methods Means Intervention Health andsafety of Health Gender identity (cognitive, andrelational). affective, in ways thatpromote subjective well-being, optimaldevelopment, anduseofmentalabilities for healthoutcomes. adverse and wellbeing, andprovide atrisk protection placethatperson from factors thatmightotherwise medications, illicitdrugs). associated withdistressthatsigni disease orin suicide prevention, orreducing accessto lethal meansamongindividuals withsuiciderisk). of anexisting condition(suchasproviding educatingproviders lithiumfor about bipolardisorders, and outreachworkers incommunityhealthprograms. social abilities; often usedinterchangeablysocial abilities;often withmentalillness. —The numberperunitofthepopulationwitha characteristic, for agiven unitoftime. —The complete state ofphysical, mental,andsocialwell-being, notmerelytheabsenceof —The instrument or object used to carry outaself-destructive—The instrumentorobjectusedto act(e.g.,chemicals, carry —Actions ortechniques thatresultinanindividual —Capacities within a person thatpromote—Capacities withinaperson positive outcomes,suchasmentalhealth —A strategy orapproach thatreducesthelikelihood ofriskonset ordelays theonset —Response to andcarefor individualsaffected following asuicideattempt ordeath. —Factors thatmake it morelikely thatindividuals willdevelop adisorder. Risk —A strategy orapproach thatisintended to prevent anoutcomeorto alter thecourse fi rmity. —The capacityofindividualsto interact withoneanotherandthe environment —The highlevels ofchronic stressexperienced by ofminoritypopulations members —An individual’s deeply-rooted internal—An individual’sdeeply-rooted senseofgender. For mostindividuals,the —A diagnosableillnesscharacterized by alterations inthinking,mood,orbehavior —Factors thatmake itlesslikely thatindividualswilldevelop adisorder. fi cials —Self-injury withnosuicidalintent. —Self-injury —Law enforcement of fi cantly interferes withanindividual’scognitive,cantly interferes emotional, or fi cers, cers, fi re fi ghters, emergencymedicaltechnicians, fl icting self-directed injurious treatment. a medicalemergencyrequiringimmediate andemergencymedical suicide intervention attempting to orisseriouslycontemplating killhim orherself orplanningto doso.Itisconsidered result ofthebehavior. Asuicideattempt may ormay notresultininjury. guidance, material aid,andspecialservices. evaluation ortreatment. and deathsby suicide. the probable consequencesofhisorheractions. attempts anddeaths. Surveillance Suicide losssurvivors survivors Suicidal behaviors Suicide attempt Suicide Suicidal plan Suicidal intent Suicidal behaviors Substance usedisorder Stakeholders Social support Screening Safety plan behavior. timely dissemination of description ofatimeframeandmethod. suicide attempt, includinganorganizedmannerofengaginginsuicidalbehavior often suchasa contribute to decisions,consultations,andpolicies. individual may useto avert ormanageasuicidecrisis. signi stimulants; andillicitdrugssuchasmarijuana,cocaine,inhalants,hallucinogens,heroin. and substances suchasalcohol;prescriptiondrugsanalgesics,sedatives, tranquilizers, fi cant adverse consequencesrelatedcant adverse to repeated use. Includesmaladaptive useoflegal —Death causedby self-directed injuriousbehavior withany intent to dieasaresultofthe —Administration ofanassessmenttool to inneedofmore in-depth identifypersons —Written sourcesthat an listofwarning signs,copingresponses,andsupport —The ongoing,systematic collection,analysis, andinterpretation ofhealthdatawith —A thoughtregardingaself-initiated actionthatfacilitates self-harmbehavior ora —A suicidecrisis,suicidalorpotential is suicide isasituationinwhichperson —Entities includingorganizations,groups, andindividualsthatare affected by and —Assistance thatmay includecompanionship,emotionalbacking,cognitive ---intended to orwishedto killhimorherself dieandthattheindividualunderstood —A nonfatalself-directed potentially injuriousbehavior withany intent to dieasa —Thoughts ofengaginginsuicide-related behavior. —Acts and/orpreparationtoward makingasuicideattempt, suicideattempts, —Behaviors related to acts,aswell suicide, includingpreparatory assuicide —See bereaved by suicide. —A maladaptive pattern ofsubstanceusemanifested by recurrentand fi ndings. —Individuals whohave apriorsuicide attempt. survived 71 Important Facts to Know About Suicide

Conclusion

The impact of suicide is devastating to entire communities. When middle and high schools across Oakland County work together to prevent youth suicide, the entire community becomes more educated and supportive of at-risk youth. As people recognize warning signs, individuals receive needed care and suicides can be prevented.

Oakland County Health Division and its partners Oakland County Community Mental Health Authority, Common Ground, Easter Seals, Oakland Schools and Training and Treatment Innovations appreciate the efforts of Oakland County schools to keep their students safe and healthy. Therefore, the Oakland County Youth Suicide Prevention Task Force intends to create more resources to address youth suicide prevention. These additions will address topics including but not limited to parent education, peer support and response to a suicide.

For additional resources related to youth suicide prevention in schools, refer to:

• SAMHSA’s Preventing Suicide: A Toolkit for High Schools www.samhsa.gov/prevention/suicide.aspx • SPRC’s The Role of Teachers in Preventing Suicide www.sprc.org/sites/sprc.org/fi les/Teachers.pdf • University of South Florida’s Youth Suicide Prevention School-Based Guide http://theguide.fmhi.usf.edu

As we move forward with the Oakland County Youth Suicide Prevention Plan, we look forward to working with your school to reduce the risk of suicide among our youth.

Revised May 2013