Depression Awareness and Suicide Prevention Training
Welcome to the on-line depression awareness and suicide prevention
training. In this training you will learn how to recognize and respond
when a student is in distress, needs help or may be thinking about
suicide.
The training will take approximately 40 minutes.
Brought to you by
University Counseling & Testing Center & Oregon College & University Suicide Prevention Project
Special funding from
Substance Abuse and Mental Health Services Administration
Thanks also to University Health Services at Univ. of California, Berkeley.
Depression is increasingly
common among college students
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Universities across the country are seeing a rise in the numbers of
depressed students, as well as those who are struggling with other
serious mental health concerns, including eating disorders, bipolar
disorder, and alcohol/drug addiction.
Multiple factors can influence a student’s mental health – academic
pressure and competition, alcohol and drug use, family and
relationship difficulties, medical and psychological problems, and
under-developed coping skills. Consider that:

In 2007, 46% of UO students surveyed said that they had felt
so depressed during the last year they could not function.2

9.6% of UO students reported that they had seriously
considered suicide.2
1. Furr, Susan, et al, Suicide and Depression Among College Students. Professional Psychology: Research &
Practice, 2001, 32, 97-100
2. American College Health Association Survey, Spring 2007
Why train non-mental health
professionals?
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Research suggests that close to half of suicidal students tell no one.
Only a small percentage currently see a therapist. Therefore,
reducing suicide on campus depends on a safety net that includes
peers, resident advisors, faculty and staff.
Ideally, this safety net can steer students to professional help before
they become suicidal.
Caring relationships with advisors and mentors reduces the sense of
isolation that often plays a role in suicide.
Why is mental health
training important for you?


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You may be worried about a student and not sure what to do. You
may have read a paper or received an email in which a student
reveals personal problems that set off alarm bells & go beyond your
expertise.
You may supervise others who have questions about students in
distress.
While the focus of this training is primarily about responding to
students, you may be concerned about a colleague who has been
depressed and withdrawn.
Some situations
you may experience

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Students with noticeably declining behavior. For instance, a student
who used to attend class regularly begins to look disheveled, stops
coming to class, and misses exams.
International students with no family or friends here. Suppose the
student’s academic situation is in jeopardy and you’re worried that
s/he’s so depressed that suicide is a real risk.
Students making alarming
comments, such as, “What’s the
point of living,” or “People would
be better off without me.” It’s clear
that they’re thinking about dying,
but you don’t know how to begin
to talk with them about getting
help
Understanding your role
As a university faculty or staff member, you can be a “gatekeeper”
for students getting help. Students in distress often turn to those
they know and trust. This online training will guide you through
three steps that can help you assist a student who is distressed and
perhaps at risk for suicide:
1. Learn to spot the warning signs
2. Know the appropriate resources
3. Connect the person to help
Signs of distress –
when to be concerned about a student
The following behaviors indicate that a student is distressed and might
benefit from a referral for counseling:

Overwhelmed to the point where everything is a problem

Significant changes in academic performance or behavior, for instance, multiple
requests for special consideration, significant decline in class attendance,
participation and/or grades

Significant physical changes, such as decline in hygiene, appearing fatigued

Strange behaviors and impaired thinking such as paranoia, incoherent speech,
inappropriate boundaries and bizarre behavior. This may come across in
written work that is not explicitly meant to be creative.

Intense emotional reactions such as intense anxiety or irritability, agitation,
prolonged or frequent crying

Threatening statements and behaviors. This includes making references to
suicide or threatening remarks and stalking behavior.
Depression is one of the most common reasons
students seek counseling.
While it’s normal for people to feel sad from time to time, clinical
depression goes beyond sadness. It tends to be pervasive, affecting
not only one’s mood, but one’s work, relationships, self esteem,
health and outlook on the future.
Clinical depression is also more long lasting, lasting two weeks or
more. While some depressed people appear sad, in other
instances, depression expresses itself by the absence of emotion or
emotional numbing. Such individuals may appear flat, subdued,
even listless.
Signs of depression include multiple symptoms
lasting over a period of several weeks
In class, depression may show itself by fatigue, missed morning
classes, declining hygiene, and poor concentration.
Other common symptoms include:

Feeling irritable or crying for no reason

Withdrawing from social contacts

Sadness or low mood

Loss of interest in activities that used to be enjoyable

Feeling worthless or unnecessarily guilty

Restless or slowed movements and speech
Clinical depression or just a mood?
You don’t need to diagnose a student. Yet, knowing some of these
symptoms can alert you to the fact that a student may be depressed.
The important point to remember is to watch for these signs and to refer
any student you think may be depressed to a mental health
professional.
Some facts about depression
 Depression is not a sign of weakness
 It is an condition that affects people of all ethnicities, nationalities
and cultural backgrounds
 It will not just “go away” if it is ignored
 Although most depressed people are not suicidal, most suicidal
people are clinically depressed.
Suicide is a permanent solution
to a temporary problem

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Suicide often is an impulsive act.
Consider that most students who are suicidal seriously contemplate
suicide for one day or less.
Most students who attempt suicide do so under the influence of
alcohol or drugs.
Of 515 individuals who were restrained from jumping off the Golden
Gate Bridge, only 5-7% had completed suicide in a 27 year follow up
period. Other long term studies show similar results.1
1. Seiden, Richard. Suicide & Life Threatening Behavior. Vol.8 (4), Winter 1978
Suicide is a coping strategy

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Suicide is often seen as a means to end unbearable pain. Most
people don’t want to die, they just want the pain to end.
People can learn to manage their emotional pain in life affirming
ways, including by learning healthy coping strategies.
An estimated 60-64% of young adults who commit suicide have a
mood disorder. Mood disorders can be treated effectively.
When pain is held, healed and transformed, it contributes to the well
being and evolution of society. Those who bear it often become
artists and writers, healers, peace makers and passionate
advocates for the oppressed.
Myths about suicide
 Many misconceptions exist about suicide
 These misconceptions can stand in the way of getting help to
those at risk.
 Take any mention of death or suicide seriously.
 Early recognition and treatment of depression and other mental
illnesses is the best way to prevent suicide.
Myths about Suicide #1
Myth: Asking about suicide will plant the idea in
someone’s head.
FACT: Asking about suicide in a straightforward
and caring way will not make one
suicidal. It will convey your concern and
invite disclosure.
Myth about Suicide #2
Myth: A person who attempts suicide almost
never shows any warning signs.
FACT: Warning signs are often present prior to
serious suicide attempts.
Myth about Suicide #3
Myth: Once people decide to take their own life,
nothing can be done to stop them.
FACT: Most people are ambivalent about
suicide. Very often it can be prevented.
What are the risk factors for
suicide?
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Hopelessness – the sense that nothing and no one can improve
their situation
Easy access to means of harming themselves (e.g., a gun, pills)
History of past suicide attempts or suicide in the family
Recent major loss (social, academic, etc.)
Impulsive or aggressive tendencies
Alcohol and other substance abuse
Untreated mental illness, especially depression, bipolar disorder and
psychosis
Lack of social support
Resistance to seeking help
Students have some unique risk
factors . . .

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Losing an important relationship. It may be the first such loss, and
the student may lack the perspective that they will get over their
sense of grief.
An academic loss disappointment, e.g., failing a class, not being
admitted to a program.
Loss of financial aid.
Loss of support system when going away to college. (International,
first year and graduate students are often at higher risk.)
Gender differences, suicide &
depression
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Depression may be harder to detect in young men since men tend to
mask emotional pain and are less likely to reach out for help.
Young men often exhibit their depression in the form of anger,
physical complaints and increased alcohol use.
While young women are more likely to attempt suicide, young men
are 4-6 times more likely to complete suicide than young women.
Several protective factors reduce
the risk of suicide

Skills in problem-solving, conflict resolution and handling difficult
emotions

Strong social support network

Easy access to and willingness to participate in mental health care

Restricted access to lethal means

Cultural and religious beliefs that discourage suicide & promote self
preservation
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Meaningful commitments and obligations, e.g., pets, children
Some sources of stress
Undergraduate students
Graduate students
Academic rigor and demands
more than accustomed to

Intense academic demands

Competition and isolation

First generation to attend college

Balancing work, school, home life

Isolation from family and friends
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Exposure to new beliefs and
people
Anxiety around oral exams,
thesis, dissertation
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Relationship with faculty advisor

Drugs and alcohol
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Departmental politics
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Overwhelmed by university
experience
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Questioning academic path

Decisions around career and
childbearing, fast track vs.
“mommy track”

Tokenism, glass ceiling, gender
politics
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Living on one’s own
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Residential living environment
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Family problems
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Disenchantment with college

Lack of support from majority
culture
How can you help?
Express your concern directly and offer to help
Be willing to listen with caring and without judgment
Use a team approach: consult with others
Be aware that the Family
Educational Rights and Privacy Act
(FERPA) allows you to disclose
information about a student to
Student Life and University
Counseling Center staff
Tips for helping a person in distress
DOs:
 Find a time to talk privately, without distractions
 Communicate your concern to the student. Be specific - what
have you noticed that raised your concern?
 Ask how they’re feeling and listen to what they have to say
 Ask if they have been thinking about suicide, e.g., “Are you
feeling so bad that you’ve thought about hurting yourself . . .
Have you thought about suicide?” If they have thought of suicide,
how detailed are their plans?
 Be supportive, remain calm, show that you care and reassure the
student that they can get help
Tips for helping a person in distress
DON’Ts:

Don’t be judgmental or argue with the student about their feelings or
choices

Don’t try to diagnose or to analyze the person

Don’t minimize the student’s feelings

Don’t ignore comments about suicide

Don’t be sworn to secrecy.

Don’t forget to seek support and consultation for yourself

Don’t put yourself in situations that feel unsafe

Don’t try to handle the crisis alone

Don’t be afraid to set limits
Asking about suicide can
be challenging
 Suicide is a socially tabooed subject. You may be afraid of saying
the wrong thing or upsetting the person. You may feel overly
responsible and unprepared: “They’re suicidal – now what do I do?”
 You might want to practice talking about suicide with someone you
know well, just to raise your comfort level.
 By asking the question, you give the student permission to reveal
this information. Most people who aren’t suicidal will tell you so.
Asking someone about suicide will not put the idea in their head.
 If the student denies that they are suicidal, yet your gut tells you
something different, you are encouraged to consult with campus
counseling staff.
Managing your reactions
Know that
you are
not alone.
Others on
Give yourself permission
to be human. It’s
normal to feel anxiety or
other difficult feelings.
Talk to a supportive
person beforehand and
debrief afterward.
campus
can assist
you.
You don’t need to be the
expert or have all the
answers.
Making the referral

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Toward the end of your conversation, if the student is struggling with
suicide, significant depression or other emotional problems, the
focus shifts toward referring him/her for professional help.
Make the referral after you
have connected with the
student and clarified the risk.
If you rush the referral, the
student may feel like they
are a “problem” you want to
dispose of.
How to refer for
counseling
 Ask student if they have ever thought about counseling
 Explain how counseling might be helpful. Perhaps you have referred
another student who was helped or you yourself had a positive
experience with therapy.
 Provide information about the Counseling Center and how to access
services.
 Stress the confidentiality of counseling. Let the student know that
meeting with a counselor doesn’t commit them to further treatment.
 Normalize counseling, e.g., “The Counseling Center sees a lot of
depressed students . . . That’s what they’re there for.”
More on referring for
counseling
 Use your relationship, e.g., “I care about you and want you to get the
help you need.”
 Some students who are closed to the idea of counseling are open to
a medical approach, and vice versa
 Offer to call ahead or walk the student over to the Center
 Call the Counseling Center and consult if you are unsure of how
concerned you should be or how you might help a particular student
 Follow up with the student to see what the outcome of the referral
was and how they are doing
Barriers to counseling
Many students who might benefit from counseling don’t come to
the Counseling and Testing Center. Some reasons include:

They don’t know about the services.
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They don’t understand what counseling is.
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They view help seeking help for a mental health problem as an
admission of weakness or are otherwise ashamed to do so. In some
cultures, to seek counseling implies that you must be “crazy.”
This is where your role is key. If you feel a student might benefit from
professional help, you can suggest counseling as an option and
encourage a student to utilize the mental health resources on campus.
What if the student is at
suicide risk?
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Take a more active role in getting the person to
professional help. If a student, walk them over
the Counseling Center.
Don’t take it upon yourself to handle the situation
alone.
Always follow up
with the student.
If a student is at imminent risk:

Don’t leave the student alone.

Do not put your own safety in jeopardy.

If on campus, call Campus Emergency at 66666. If off campus, call 911
What if the student needs help
but is resistant it?
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In 2005, UO adopted a Suicide Prevention Policy to help identify
students at risk and to intervene with suicidal students who are
resistant to getting help. This policy recognizes that members of the
university community have a responsibility to maintain a standard of
self care. Suicide is a real risk for students, and the effect of an
attempted or completed suicide on the campus can be quite
devastating and far reaching.
Faculty and staff are encouraged to consult with the Counseling
Center. If a student is determined to be at significant risk, the Dean
of Students Office will initiate a mandatory suicide assessment
conducted by Counseling Center staff.
While this assessment may feel coercive, many students referred
eventually come to appreciate the University’s concern and the
opportunity to address the underlying reasons for their suicidality.
What counseling services are
available to students?
 The Counseling and Testing Center has a diverse staff of licensed
mental health professionals and trainees.
 All students who seek counseling receive an initial assessment.
Based on this assessment and available resources, the student may
be assigned an individual counselor, referred to one of several
groups or referred for therapy in the community.
 The Center sees roughly 1,600 students in a given year.
 We work closely with psychiatrists and other Health Center staff
when medication is a preferred treatment option.
 The Center also operates a Crisis Line that is available nights and
weekends except during University holidays and break periods.
How to Access Counseling
The Counseling and Testing Center is located on the 2nd floor of
the University Health and Counseling Center Building
Hours: Monday thru Friday, 8 a.m. to 5 p.m.
Telephone: 346-3227

Students access services via a drop-in clinic which operates M-F 1–4.
Students who cannot make these drop in hours are offered scheduled
intakes.

Students with urgent needs can be walked over to see a counselor on
duty during open hours.

Services are available and free to currently enrolled UO students
Other Important Contact Numbers:

UO Crisis Line (eves & weekends) – 346-4488
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Office of Student Life – 346-3216
Consultation is the key

Err on the side of caution

If in doubt, consult with others

Don’t try to handle a critical situation on your
own

The Counseling and Testing Center
provides telephone consultation to staff and
faculty
Applying what you’ve
learned . . .
To help you evaluate what you’ve learned
from this presentation, we’d like to
present you with some scenarios that you
or a colleague may encounter
Consider scenario #1:
You've noticed some changes in Sheila and are concerned about
her. Sheila seems hyperactive and is becoming more agitated
everyday. You hear her talking to herself and her behavior is
beginning to scare other students. You mention this to a colleague
and find out that other faculty are also concerned about her.
What would be the
best way to handle
the situation?
What would be the best way to handle
the situation?
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

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A. Put an anonymous note in the student's mailbox
suggesting that she visit the Counseling and Testing
Center.
B. Ask to speak with the student privately.
C. Ignore the situation because you might aggravate things
by drawing more attention to her.
D. Request that Student Life speak to the student because
they are more experienced in these situations.
Recommendation:
Answers B or D would both work depending on the situation.

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An anonymous note could make the situation worse. The student may
worry about who wrote the note and how she is being watched by her
colleagues.
Do not ignore someone who needs help. We all need help and support at
different times in our lives. It can be reassuring to know that our problems
are real and that other people notice them. Offering someone help can be
the beginning of their road to recovery.
Speaking privately with a student about the changes you've noticed shows
that you care about the student's welfare. It also conveys to students that
they do matter.
Student Life may have more information from others on campus. Staff
are able to reach out and intervene with a student who comes to their
attention.
Consider scenario #2:
Marcos is an international student who you have known to be energetic
and interested in many activities. For the past month, he has seemed
to have little energy and often appears sad. He has always dressed
casually, but recently he has looked disheveled and seems not to care
as much about his appearance. You don't know Marcos very well, but
you've chatted several times,
so you decide to approach
Marcos to ask if something is
bothering him. He shrugs off
the question and avoids you.
You try one more time, and he
breaks down in tears and says
he cannot talk about it.
What should you do next?
What should you do next?

A. Leave him alone.

B. Offer to "be there" for him when he wants to talk.


C. Call the Counseling Center for consultation about how to
proceed.
D. Offer to go with Marcos to the Counseling Center and
state that he doesn't have to talk about it with you but that
he can talk confidentially with a counselor.
Recommendation:
The best options here are a combination of B and C and D.
Marcos is clearly experiencing something very difficult right now. Although you want to
respect his privacy and desire to not discuss the issue, you should not just leave him alone.
You can respect his privacy and still help him by saying something like, "okay, we don't
have to talk about it, but I want you to know that we have a counseling center on campus
where you can talk to a professional confidentially."
Offering to "be there" for Marcos is a good option. It lets him know that you are a good
resource and that you care about how he is doing. Make sure you follow up with Marcos and
see how he is doing in a few days. You can always refer him to the Counseling Center even
if things seem to be a little better, because chances are the original issue is still affecting
him. You can call the Center for consultation. When a trained counselor hears about a
situation, they may recognize potential issues that you may not.
Offering to walk Marcos to the Counseling Center is another caring option. He may accept
your offer and be relieved to have the option of talking to someone confidentially instead of
to you. If he doesn't want you to go to with him, you can still give him information about
how to access services. If Marcos' crying is inconsolable and he seems to need more
support, find a private area for him to sit down and then proceed from there. Ask another
person for help if necessary.
Consider scenario #3:
Cleveland, who works in your office, has begun to display spotty
attendance at work. Normally, he drops by your desk to talk, but lately he
has stopped visiting with you. You’ve noticed that he looks depressed and
that his old friends no longer call. Cleveland has classes at 8 a.m., but he
tells you he just can’t get out of bed in the morning and has been missing
class.
Yesterday, you noticed that his mood suddenly had lifted. He offers to give
another employee his mountain bike, saying that it was no
longer needed. This morning Cleveland
left his on-line blog open on the
computer. The screen was open to a
rambling note that made reference to
global warming, the “futility of life” and
the “big, quiet calm on the other side.”
What should you do?
Which of these things might you
do?


A. Alert someone else in the department so that you can
work as a team to help the student
B. Call the student at their residence to check on their well
being

C. Call Student Life

D. All of the above
Recommendation:
All of the above are good options.
If you sense that a student may be at risk for suicide, it is best to
bring in more help. Others may have more information that bears on
the student’s well being. In this situation, the student clearly has
been depressed and seems to be thinking about suicide. His sudden
improvement, along with giving away his Mt. Bike and the note on his
blog, are red flags. While we can’t always prevent another’s suicide,
caring relationships are a protective fact against suicide. Student Life
could reach out and check on the student’s welfare. They can also
involve parents if that is deemed to be helpful.
For further information . . .
Here are some other resources you may find
helpful:
UO Suicide Resources:
http://counseling.uoregon.edu/OUSPP_Handouts.htm
Suicide Prevention Resource Center’s College Resources:
http://www.sprc.org/featured_resources/customized/college_s
tudent.asp
Suicide.org – Virtual articles on various topics:
http://www.suicide.org/
American Foundation for Suicide Prevention:
http://www.afsp.org/
(includes links for survivors of suicide)
Thank You
Now that you’ve experienced this online training, we
would appreciate it if you would take a few moments to
evaluate the training. This will also allow us to send
you a certificate of completion. If you are willing to
complete this brief evaluation, please click the link
below. Please print the PDF, fill out and send through
campus mail to: UO Counseling & Testing Center.
To the Evaluation
To the Survey