Suicide Contagion and Clusters-Part 2: What Can A

OFFICE OF SUICIDE & VIOLENCE PREVENTION NOVA SOUTHEASTERN UNIVERSITY Newsletter – Spring/Summer 2020 Dr. Scott Poland & Dr. Douglas Flemons, Directors In this issue: Page Suicide Contagion and Clusters: Part 2…………………..……………………..………..… 1 COVID-19 and Suicide ………………….……………………………………………………… 7 Dr. Peter Langman Interview: Why Kids Kill …………………………………………………. 8 Helping Survivors of School Shootings ………………………………………….……….….. 12 Kevin Hines Shares Lessons from his Suicide Attempt..................................................... 14 Suicide and Violence Prevention Resources ……………….……………………………... 17 UPCOMING SUICIDE CONTAGION EVENTS: AND CLUSTERS-PART 2: Dr. Scott Poland has WHAT CAN A SCHOOL recorded a webinar on suicide prevention PSYCHOLOGIST DO? as part of NSU College By Marina Niznik, Scott Poland & Richard of Psychology’s series of webinars on Lieberman helping children and In Part 1 of this series (Lieberman, Poland, & Niznik, Postvention is de- families cope during 2019), we discussed the phenomenon of contagion fined as an inter- the COVID-19 and identified adolescents as the most susceptible vention after a pandemic. age group for imitating suicidal behavior. Beyond suicide. The term was specifically suicidal behavior, we may be coined by Schneid- Recordings and future underestimating the full impact of being exposed man (1973), whose webinars can be to a death by suicide—a contention supported by basic view was, “the accessed for free at: Cerel and colleagues (2018), who found that of largest public health approximately 135 people exposed to a death by problem is neither the www.nova.edu/ suicide, as many as 30% found it to be a life- prevention of suicide sharkchats changing event. Ultimately, the primary goal of nor the manage- postvention is to identify those now at risk and ment of suicide prevent the next suicide. Part 2 of this series focuses attempts, but the See Page 7 for on limiting contagion and highlights the many alleviation of the potential roles of the school psychologist in suicide effects of stress in the more information postvention. Frequently-asked questions (FAQ) are survivors whose lives regarding COVID- addressed in a special section at the end of the are forever altered.” 19 and suicide. article. Research has shown Nova Southeastern University that postvention efforts in the schools are often too support. Identify the victim's siblings and friends who short in duration and focus on too few children. may need assistance. Discuss the school's post- While many districts have policies established for vention response. Identify details about the death intervening with suicidal students, few spell out a that could be shared with outsiders. Discuss funeral process for postvention or how they will intervene in arrangements and whether the family wants school the aftermath of a student death by suicide. School personnel or students to attend. Communicate psychologists play a critical role in guiding district directly to parents and students, balancing the policies and procedures, identifying and alleviating family's wishes for privacy and needs of the students the distress of suicidal, bereaved individuals, (see FAQ 3). Utilize the After a Suicide: Toolkit for reducing the risk of imitative suicidal behavior, and Schools (2nd ed.) for templates of statements for promoting the healthy recovery of the impacted parents and students and share with your principal. community (see FAQ 1). Next Steps We have assisted many school districts in the Triage staff first and notify them in person, if possible. aftermath of point clusters (multiple student deaths Allow grieving staff to be relieved from the by suicide, in geographical proximity, over a short classroom. Conduct a faculty planning session to period of time), and in each case the local school review the referral process and staff role in psychologist spearheaded the comprehensive postvention. Remind staff that how they respond district response. Working in collaboration with has a great impact on potential traumatization, administrators and other school mental health particularly in young children. Share resources for personnel (such as counselors, social workers, and students who need additional support. Share crisis nurses), school psychologists provided guidance, hotline information via the school's social media resources, and ultimately, leadership. They helped page, and send out information about safe their communities see this was not a school problem messaging via the commonly-used social media but a serious community crisis that required sites directly to adolescents. Post relevant support commitment and determination to respond (see information, such as text line or crisis hotline FAQ 2). The remainder of this article provides numbers in visible locations for students and staff. suggestions regarding some of the key roles and actions that may be taken by school psychologists Conduct educational/psychological sessions (see in these situations. FAQ 4). Avoid large assemblies or large groups (See Toolkit, p. 30) where students cannot ask questions Immediate Actions or be easily monitored for their reactions (see FAQ Respond immediately when a student suicide 5). Provide support to students in small groups or in occurs. Confirm the facts and gather information. classrooms. Share facts, dispel rumors, allow Verify that the death was by suicide, preferably by students to share, and then normalize a wide range talking directly to the student's parents, law of reactions, and look for students who may be enforcement, or coroner. Work closely with the showing signs that they are significantly impacted. school administration and community resources to recognize the possibility of contagion and to Identify and screen students for suicidal identify students most at risk. Students at risk may ideation/behavior. Conduct primary screening and include: students who were close to the student triage students utilizing three factors: those who died, students who have previously physically proximal to the event, those emotionally considered or attempted suicide, students who proximal, and those with preexisting vulnerabilities. have been exposed to the suicide and have other Train or refamiliarize faculty members, parents, and risk factors, students who have major life events students on how to recognize warning signs and occurring, and students exposed via social media. identify support services. Have mental health providers screen for suicidal ideation/behavior. Mobilize a crisis response team (assist the principal Conduct secondary screening with students who in establishing this team before the crisis occurs!). may present an elevated risk for suicidal behavior Collaborate with team members to determine the or have been affected by the suicide to determine impact of the crisis and advise the principal on how if interventions are necessary. Some exposed to proceed. Notify key district and community students will have sufficient ability to cope. Notify partners to increase screening and support of parents/guardians of those assessed with suicidal affected students. risk and recommend community-based mental health services as needed. Coordinate with Reach out to the family. Offer to accompany your community providers with appropriate signed principal to the home. Express sympathy and offer releases to do so. 2 Nova Southeastern University Assess high-risk students for suicidal ideation or suicide” to replace “committed suicide.” Work with behavior. “All school mental health professionals news reporters to inform, limit details, and share the have the ethical and practical responsibility to resources listed at the end of this article. Educate conduct suicide risk assessment” (Singer, Erbacher, students on safe messaging on social media. & Rosen, 2018, p. 8). Suicide risk assessment is an Encourage parents, staff, community members, essential role of the school psychologist in suicide and the students themselves to monitor intervention and requires specialized training communication that is concerning and to take (Lieberman et al., 2014). Risk assessment includes: action to get help for adolescents in need (via a identifying suicidal ideation, intent, and plan; trusted adult, crisis hotlines, crisis text lines, etc.). assessing for risk and protective factors; assessing for access to lethal means and experience with Plan for the Long Term self-injury to address habituation to pain; and Follow up with all referred students in the days, creating a risk formulation. Many districts that we weeks, and months that follow, particularly with have consulted with have utilized the Columbia siblings and relatives of the victim. Be mindful of Suicide Severity Rating Scale for assessment. planning for anniversaries, birthdays, and graduation. Debrief and evaluate the response. Provide individual and group counseling to Collect data throughout the postvention on affected peers. Provide or refer students for students referred, parent notifications, and student individual counseling. This can include school- hospitalizations. Evaluate these data and update based counseling, safety planning, or referral to procedures. community agencies or mental health practitioners for treatment. Safety planning should include Remember that postvention leads back to triggers, warning signs, thoughts, moods, coping prevention. Implement evidence-based mental strategies, agreement to remove access to means, health promotion programs beginning in and steps to take for help in a crisis. Parents should

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