Center and Crisis Services
&
An Introduction to Youth Suicide
Prevention/Intervention/ Postvention
o
o
o
o
o
o
o
o
o
o
o
o
Overview of DCMHMR and regular services
Overview of Crisis Services
Suicide Myths and Truths
Legal Implications for Schools
Best Practices for School Suicide Prevention/Intervention /
Postvention
Statistics for Youth Suicide
Crisis Model and How to Identify a High Risk Student
Do’s and Don'ts for Suicide Intervention and Postvention
Social Networking
Peer Support
Suicide Contagion/Clusters/Copy Cat
Role Play and Case Studies
2
3




The local mental health and mental
retardation authority for all of Denton County
Non – profit organization (501 C-3)
Unit of local government administered by a
nine member board of trustees which are
appointed by the Denton County
Commissioners Court
Contract provider for the Texas Department
of State Health Services and Texas
Department of Aging and Disability Services
4
Denton County MHMR Serves Children and
Adolescents from the ages of 3-17 that have
severe emotional, behavioral or mental disorders.
All potential clients must receive an intake which can
be scheduled through the hotline.
We accept Children and Adolescents with Medicaid or
those that are uninsured. Fees are determined
according to a sliding scale.
5




Psychiatry: Includes assessment of
symptoms and prescription/
monitoring of medications.
Assessment Services
Case Management and Rehabilitative
Services.
Counseling: Time Limited individual
and family counseling.
6




Crisis Hotline and Resolution Services
Skills Training: Facilitates the client’s
community integration and provides
opportunities for improved functioning.
Family Partner: Provides wraparound team
process.
Parent Support Group: Tuesdays in
Lewisville and Denton once a month at 6:00
pm.
7
Home and Community-Based Services (HCS):
o
o
o
o
o
o
o
o
Care Coordination
Service Coordination
Adaptive aids
Minor home modifications
Counseling and therapies (includes audiology; speech/language
pathology, occupational or physical therapy; dietary services; social
work; and psychology)
Dental treatment
Nursing
Residential assistance
o
o
o
o
o
o
o
Supported home living
Foster/companion care
Supervised living
Residential support
Respite
Day habilitation
Supported employment
8
General Revenue (GR) Services:
o Service Coordination
o Community Support
o Respite
o Employment Assistance
o Supported Employment
o Nursing
o Behavioral Support
o Specialized Therapies
o Vocational Training
o Day Habilitation
9
Texas Home Living Waiver Program Services:
o Adaptive aids
o Minor home modifications
o Specialized therapies
o Behavioral support
o Dental treatment
o Nursing
o Community support
o Respite
o Day habilitation
o Employment assistance
o Supported employment
10
 Denton
County MHMR was
granted additional funding by the
state to expand and improve
mental health crisis services
within Denton County.
 Crisis Redesign was implemented
December 1, 2007
11
Two clinicians to assess
individuals during business hours
and one after hours.
 Response/wait time was long.
 Averaged 80 emergency
screenings per month.
 No immediate crisis services
available.

12
Since December 1, 2007:
-Average 180-200 emergency screenings per
month.
- Response time has decreased.
- Case management
- Psychiatric services if appropriate.
- Counseling services if appropriate.
- Mobile Crisis Outreach Teams increased –
over 25 day staff! Does not count after hours
teams!
- Substance abuse counseling.
- Additional availability of short term hospital
contract bed days.
13
Screening
Location and
Time
Dec.1, 2007
Dec. 1, 2008
Dec. 1, 2008
Dec. 1, 2009
Dec.1, 2009
Dec. 1, 2010
Community
902
1,155
1,192
Office
319
560
833
Total
1,221
1,715
2,025
8a-5p
756
1,085
1,368
Nights/
Weekends/
Holidays
465
630
657
14
From December 1, 2010 –
May 31, 2011
The Crisis Team has completed
928 Screenings so far!
15
2008
Jan.-Dec.
2009
Jan.-Dec.
2010
Jan.-Dec.
2011
Jan.-July
72
214
239
155
16



A crisis is a stressful situation or set of events
that are perceived or experienced as intolerable
and unsolvable because the individual’s
customary coping strategies and problem
solving skills are exceeded
In a crisis an appropriate coping response is
unknown, but in an emergency it can readily be
implemented.
DCMHMR defines a crisis as someone who has
thoughts of suicide, homicide and/or has
deteriorated to the point to where they are a
risk of harm to themselves or others.
17





Denton County MHMR provides a crisis
hotline service accredited by the American
Association of Suicidology (AAS)
Hotline staff will provide information,
support, intake appointments, intervention,
and referrals to callers 24 hours a day, 7
days a week.
Hotline is available to anyone
Hotline Number:1-800-762-0157
TTY Hotline Number:1-800-269-6233
18
◦ To determine the risk of harm to self or others.
◦ To assess Acute and Chronic risk factors of
suicide.
◦ To check the individual’s mental status for
impaired or disturbed thought patterns.
◦ To assess the individual’s social environment for
distress or support.
◦ To assess substance abuse.
◦ To determine what is the least restrictive
environment in which an individual can safely
function and receive treatment.
◦ To facilitate inpatient treatment for the individual
if the clinician determines that to be the least
restrictive environment.
19
› All Screenings undergo the following assessment
process:
 Emergency criteria met
 Drug/alcohol levels acceptable for mental health
treatment. BAC must be at below .08 or 80 and be
Narcan free for 24 hours for team to screen.
 Client must be medically stable for team to screen.
 Physical problems - See Hospital Exclusionary
Criteria for considerations
 Intellectual and Developmental Disabilities
considerations
20
 Secure locations include jail, DCMHMR office and
Hospitals (medical and psychiatric).
 In the Hospital ~ has the psychiatric consult
recommended inpatient treatment? If so, is the patient
insured and will they go voluntarily?
 Police to stay for entire assessment if environment is
an unsecure location or client is combative.
 If it is a child, we attempt to locate the
parent/guardian. CPS will be contacted for any
unaccompanied minors.
 Response time goal is within one hour.
21




Mobile Crisis Outreach Teams (MCOTs) provide
face-to-face clinical assessments to individuals
in crisis 24 hours a day, 7 days a week in Denton
County.
A MCOT consists of 2 individuals, a Qualified
Mental Health Professional, and a licensed
professional. The licensed professional can
either be a Licensed Professional of the Healing
Arts (LPC, SW, etc.) or a Registered Nurse.
All MCOT Team Members are AAS Certified Crisis
Workers.
Teams will respond to appropriate crisis calls
from hotline or walk-ins during business hours
at our Denton and Lewisville outpatient clinics.
22




Crisis outpatient services consist of psychiatric
services, medication, cognitive behavioral
counseling, chemical dependency counseling,
case management and referrals to outside
organizations.
All individuals seen for a crisis assessment meet
face to face with a crisis staff member within 24
hours for a follow-up if outpatient services are
recommended.
Individuals are then seen by the team at least
weekly.
Crisis Services are time limited.
23
If there is a student that has been identified
as high risk, do the following:
1.
DO NOT LEAVE THE CHILD ALONE.
2.
Notify the parents and make every attempt to
have them come in.
3.
Have campus security or police secure the scene.
4.
Call the Crisis Line who will in turn contact
MCOT. Please make sure the number of the
person most familiar with the situation is left with
the hotline
5.
MCOT will determine the student’s least
restrictive options.
24
25
Myth: Adolescents who talk about suicide do not attempt or complete
suicide.
Truth: One of the most dire warning signs of adolescent suicide
is talking repeatedly about one’s own death. Adolescents who
make threats should be taken seriously and provided the help
they need (25,16).
Myth: Educating teens about suicide leads to increased suicide
attempts, since it provides them with ideas and methods about
killing themselves.
Truth: When issues concerning suicide are taught in a sensitive and
educational context they do not lead to, or cause further
suicidal behaviors (23).
26
Myth: Suicidal behavior is inherited.
Truth: There is no specific suicide gene that has ever been
identified in determining or contributing to the
expression of suicide (15,20,17,5).
Myth: Most teenagers will not reveal that they are suicidal or
have emotional problems for which they would like
emotional help.
Truth: Most teens will reveal that they are suicidal. Although
studies have shown that they are more willing to discuss
suicidal thoughts with a peer than a school staff
member (25).
27
Myth: Adolescent suicide occurs only among poor
adolescents.
Truth: It occurs in all socioeconomic groups (5,4,19) and
socioeconomic variables have not been found to be
reliable predictors of adolescent suicidal behavior.
Assessing social and emotional characteristics are more
helpful to determine if a youth is at increased risk
(25,15,5,4,19).
Myth: Suicide occurs in great numbers around
holidays in November and December.
Truth: Highest rates are in May and June and lowest rates are in
December. (3)
28
Myth: Elementary school children are
not at risk for suicide.
Truth: While rates of completed suicide
are considerably lower in this
population, statistics show that
it does happen (22).
29
Landmark Case:
Wyke vs. Polk County School Board 11th
Federal Circuit Court 1997:
Found the district liable for not offering a
suicide prevention program, providing
inadequate supervision of a suicidal student
and failing to notify parents when their
child was suicidal.
30
Landmark Case:
Mares vs. Shawnee Mission Schools Johnson
County District Court 2007:
The school system settled out of court after
being sued following the suicides of two
brothers. The key issue in the case was failure
to implement suicide postvention procedures
after the first death.
31
Structure
Control
Support
32
Have a strong Crisis Management Plan and Policies as well!



The plan should include the most current information about
suicidal behavior, risk factors, protective factors, contagion
and prevention guidelines.
The Crisis Response team should be identified and provided
additional training to fulfill individual roles (11).
The plan should include detailed instructions identifying each
person’s role in response to suicide threats, attempts or
completed suicide (11). This should include staff that are
identified and not identified as Crisis Response Team
Members.
33




This plan should be practiced and reviewed
regularly (11).
Each teacher and counselor should keep a copy of
the plan in the classroom as well as offices so it is
easily accessible (11).
Encourage all staff to collaborate in recognizing at
risk/high risk students (11).
Provide parents and students with opportunities to
become involved in suicide prevention strategies
offered by the school (11).
34






Identify who your front line staff will be for children at higher
risk.
Front line staff should screen high risk youth using an
approved tool (11).
Consider having front line staff accredited through AAS
Program.
Conduct repeated screenings on high risk students once or
twice every school year (11).
Consider providing peer assistance programs.
Evaluate the current plan/policies for effectiveness regularly
(11). Who will address media, notify parents and begin to
bring in community resources?
35
 Establish
collaborative relationships with
community agencies such as police, clergy
and mental health centers (11).
 Provide staff with contact information on
these resources so appropriate referrals are
made.
 If you identify a student as being a
moderate or high risk of suicide, call the
Denton County MHMR Hotline.
36
Statistics for
Youth
Suicide
37
o
o
o
o
Suicide is the third leading cause of death for youth ages 1024 behind accidents and homicides (7).
In 2007, there were 4,320 completed suicides for youth ages
10-24. For those aged 20-24 the rate was 12.5 per 100,000.
For those aged 15-19 the rate was 6.9 per 100,000. For
those aged 10-14, less than 1 per 100,000 (7).
Male youth die by suicide five times more frequently than
female youth (7). Females attempt three times more
frequently than males (7).
The majority of youth who died by suicide used firearms
(45%) and suffocation was the second most commonly used
method (38%) (7).
38


A Survey Conducted by the CDC among High
School Students in 2009 revealed the
following:
13.8% of students in grades 9-12 seriously
considered suicide in the previous 12 months
(17.4% of females and 10.5% of males)(6).
6.3% of students reported making at least
one suicide attempt in the previous 12
months (8.1% of females and 4.6% of
males)(6).
39
Findings from a study conducted by
scientists at the Centers for Disease
Control and Prevention indicate that
youth threatened or injured by a peer
were 2.4 times more likely to report
suicidal thoughts, and 3.3 times more
likely to report suicidal behavior than
non-victimized peers (14).
40


Native American/Alaska Native Youth have
the highest rate of suicide with 14.8 per
100,000. White youth are next highest with
7.3 deaths per 100,000 (7).
While the rate of completed suicide for
Hispanic youth is lower than that for NonHispanics (5.4 per 100,000)(6), school aged
Hispanic youth self-report higher rates of
feeling sad or hopeless, of thinking about
suicide, and of attempting suicide (7).
41




Lesbian, gay, and bisexual youth are up to four
times more likely to attempt suicide than their
heterosexual peers (18).
More than 1/3 of LGB youth report having made a
suicide attempt (10).
Nearly half of young transgender people have
seriously thought about taking their lives and one
quarter report having made a suicide attempt (13).
LGB youth who come from highly rejecting families
are more than 8 times as likely to have attempted
suicide than LGB peers who reported no or low
levels of family rejection (21).
42
All Races/Both Genders/Exact Numbers
10
1999
2000
2001
8
2002
6
2003
2004
4
2005
2
2006
2007
0
Ages 5-14
Ages 15-24
2008
43
Trigger
Growth/Healing
Accumulation of
Losses
Pre-Crisis
Cycle of Escape
Passage of Time
Crisis
44









Withdrawal from family and friends (11)
Preoccupation with death (11)
Marked personality change and serious mood change(11)
Difficulty concentrating (11)
Difficulties in school (decline in quality of work) (11)
Change in eating and sleeping habits (11)
Loss of interest in pleasurable activities & things one cares
about (11).
Frequent complaints about physical symptoms, often related
to emotions such as stomach aches, headaches, fatigue, etc
(11).
Persistent boredom (11).
45







Actually talking about suicide or a plan (11)
Exhibiting impulsivity such as violent actions, rebellious
behavior or running away (11).
Refusing help, feeling “beyond help”(11)
Complaining of being a bad person or feeling “rotten inside”
(11).
Making statements about hopelessness, helplessness, or
worthlessness (11).
Not tolerating praise or rewards (11)
Giving verbal hints such as: “ I won’t be a problem for you
much longer,” “Nothing matters,” “It’s no use,” and “I won’t
see you again” (11).
46





Becoming suddenly cheerful after a period of
depression-this may mean that the student has
already made the decision to escape all problems
by ending his/her life (11)
Giving away favorite possessions (11)
Making a last will and testament (11)
Saying other things like: “I’m going to kill myself,”
“I wish I were dead,” or “I shouldn’t have been
born.” (11)
Using social media to convey these messages.
47
Acute Risk Factors:
I – Ideations of Suicide
S -Substance Use Increase
P - Purposeless
A – Anxiety/Insomnia
T - Trapped
H – Hopeless
W - Withdrawn
A – Angry
R – Reckless/Self-Injury
M – Mood Swings
Are there Firearms in the household?
Contagion or Imitation a possibility?
48














Previous Suicide Attempts (2)
Diagnosable Mental Illness (2)
Previous Mental Health Hospitalizations (2)
Chronic Isolation (2)
Family History or exposure to suicide (2)
Mental Health Issues (2)
Childhood Abuse (2)
Significant Medical Illness (2)
Low Self-Esteem (2)
Poor Coping Skills (2)
Life Stressors/Losses/School problems/Living Alone(11)
Being Bullied(11)
Sexual Orientation(11)
Juvenile Delinquency (11)
49
Acute Risk
Factor
Low Risk
Moderate Risk
High Risk
Ideations of
Suicide
None or Passive
thoughts of death
Active, no plan or
preparations, may
threaten
Constant, planned,
preparations,
intent, means
available
Substance Use
None
As usual
Excessive,
increased
Purposeless
Has Reasons for
Living
Ambivalent;
reasons for
dying>for living
Sees no reasons
for living, no
purpose in life;
Feels burdensome.
Anxiety
No significant
signs or mild
anxiety
Moderate anxiety,
restlessness,
agitation or slight
insomnia
Agitated, restless,
difficulty sleeping
or panicky
50
Acute Risk
Factor
Low Risk
Moderate Risk
High Risk
Trapped
Able to see
choices, does not
feel hopeless
Some constricted
thinking
Hopeless
Looking forward,
reasonably
positive regarding
self, others and
the future
Some pessimism, Negative feelings
some negative
about self, others
feelings regarding and the future
self, others and
the future
Withdrawal
None evident
Less active, less
pleasure (and
interest) in usual
activities, some
decline in
performance
(school, work)
Sees choices as
continued pain
versus death, sees
no way out
Socially Isolated,
closed off, acutely
and unhappily
alone. May have
stopped engaging
in previous
activities
completely.
51
Acute Risk
Factor
Low Risk
Moderate Risk
High Risk
Anger
Slight irritations at
worst
Angry outbursts,
Irritable, Sees
others as not
supportive
Marked anger or
rage, harboring
fantasies of
revenge, paranoid
Recklessness
Nothing unusual
Minor risk taking
Acting without
thinking, risking
dangerous
consequences in
behavior
Mood Change
No change
Slight downturn in
mood
Dramatic Shift in
Mood
52








Family connectedness and school
connectedness(2)
Reduced access to firearms(2)
Safe Schools(2)
Academic achievement(2)
Self-Esteem (2)
Positive Relationships with other school
youth(11)
Lack of access to means (11)
Help-seeking behavior (11)
53






Impulse control (11)
Problem solving/conflict resolution abilities
(11)
Stable Environment (11)
Access to care for mental/physical and
Substance Use Disorders (11)
Responsibilities for others/pets (11)
Spiritual Connectedness/Religion (11)
Anything the youth states that is a reason for living!!!
54
When having a conversation with a youth that
you think is at risk, find out about thoughts
of suicide quickly after establishing a rapport.
Ask what you need to know directly! Younger
children tend to be very concrete thinkers.
Avoid abstraction. Asking a youth if they
want to “hurt themselves” may mean cutting
in their mind.
55


Don’t ask leading questions like, “You’re not thinking of
suicide are you”? Chances are you will not get a truthful
response (24).
Sample questions to uncover suicidal thinking (24):
• Sometimes, people in your situation (describe the situation)
lose hope; I’m wondering if you may have lost hope, too?
• Have you ever thought things would be better if you were
dead?
• With this much stress (or hopelessness) in your life, have
you thought of hurting yourself?
• Have you ever thought about killing yourself?
56


If there are thoughts of suicide, ask specifically about
frequency, duration and intensity (24).
Sample questions to assess suicidal ideation (24):
• When did you begin having suicidal thoughts?
• Did any event (stressor) happen before the
suicidal thoughts?
• How often do you have thoughts of suicide? How
long do they last? How strong are they?
• What is the worst they have ever been?
• What do you do when you have suicidal thoughts?
• What did you do when they were the strongest
ever?
57


After discussing suicidal thoughts, inquire
about plan and the means (24).
Sample questions to assess suicidal planning
(24):
• Do you have a plan or have you been
planning to end your life? If so, how would
you do it? Where would you do it? When
would you do it?
• Do you have the (drugs, gun, rope) that
you would use? Where is it right now?
58


Determine the extent to which the patient expects to carry
out the plan and believes the plan or act to be lethal vs. selfinjurious (24).
Sample questions to assess intent (24):
• What would it accomplish if you were to end your
life?
• Do you feel as if you’re a burden to others?
• How confident are you that this plan would
actually end your life?
• What have you done to begin to carry out the
plan? For instance, have you rehearsed what you
would do (e.g., held the pills or gun, tied the
rope)?
59

Sample questions to assess intent
(cont.)(24):
•How likely do you think you are to carry out your
plan?
• What stops you from killing yourself?
• Have you made other preparations (e.g., given
away prized possessions)
• What makes you feel better (e.g., contact
with family, use of substances)?
• What makes you feel worse (e.g., being
alone, thinking about a situation)?
60




Anyone with training can ask the questions noted
in slides 53-58, however, determination of risk
should be assessed by a counselor, MCOT or other
Mental Health or Medical Professional.
Practice asking these questions prior to a real
encounter (24).
If you suspect the child is not being honest, ask
questions in different ways until there is
reconciliation between what the child says and
what you are seeing (24).
Ask any collaterals for clarification. This may
include parents, friends and police (24).
61



Youth will often talk to each other about
topics that they are uncomfortable
discussing with adults
Arm children with appropriate information
on suicide. This should include information
on when to tell an adult. Help them
understand what should be a cause for
concern.
Consider a peer mediation program and
train frontline youth.
62



Avoid using a brief (2-4 hour), one-shot approach
in assembly presentations or classes. A prolonged
approach is better (11).
Curriculum should include myths, facts, risk
factors, warning signs, what they can do to help
and resources (11).
Curriculum approaches that attempt to increase
students’ self esteem, coping and problem solving
skills may in turn increase the likelihood that they
may seek help if they are in need (11).
63



Avoid approaches such as suicide as a reaction to stress,
media depictions of suicidal behavior or having a youth that
attempted suicide give testimonials. Curriculum could be
implemented in already established health or life-skills
classes (11).
Research has shown that curriculum length of anywhere from
three classes (40-45 minutes each) to a semester long class
are effective at significantly reducing suicidal ideations,
hopelessness and depression in adolescents (11).
There are established toolkits on the resource list provided
that could be helpful in curriculum development.
64




A suicide death will be discussed using this medium and
there will often be a spontaneous memorial posted.
Someone should monitor discussions on social media. Look
for rumors, information on gatherings, derogatory messages
and indications that a youth may need assistance (1).
Be a part of the memorial by posting positive and accurate
help related information and hotline numbers (1).
Find a student leader to help in these efforts and assure them
that you are interested in supporting a healthy response to
their peer’s death and not trying to thwart communication (1).
65
WHAT TO DO
WHAT NOT TO DO
Ensure a student’s safety (11).
Debate whether suicide is right or wrong or
promise secrecy or confidentiality. NEVER
leave them alone or send them away if they
have expressed suicidal ideations (11).
Listen, be direct, remain calm and know your
limits (11). If situation is beyond your scope,
find someone to take over.
Panic or act shocked (11).
Be empathetic, honest and take it seriously
(11).
Rush, lose patience, give advice, be
judgmental, preach, or minimize (11).
Make sure the student knows what is going
on during the intervention process (11).
Surprise the youth by escorting then to a
large room with several members of the
crisis intervention team (11).
Get additional assistance if needed (11).
Physically remove a weapon (11).
Inform Parents/Caretakers (11).
Keep the situation to yourself (11).
66
WHAT TO DO
WHAT NOT TO DO
Have an established plan to deal with the
media which will include one identified
spokesperson. Provide factual information
and concern for the family. Encourage
reporters to provide information that
increases public awareness of risk factors,
warning signs, hotlines and resources (11).
Avoid sensationalizing, glorification or over
simplifications of the suicide. Avoid graphic
descriptions/details and front page
headlines. Displays in the media of
memorializing can increase the likelihood of
imitation/contagion/copycat suicides. Staff
should not talk to the media or spread
rumors (11).
Follow the established Crisis Management
plan. This should include activation of the
Crisis Response Team, securing facts about
the death (ME Report), informing the
Superintendent, calling the Family of the
deceased, scheduling a time and place to
meet with faculty and other school staff,
contacting community support services,
arranging a meeting for parents, meeting
with students in small groups, offering
support services and debriefing with staff
each day for at least 5 days (11).
Avoid being unprepared.
67
WHAT TO DO
WHAT NOT TO DO
Assure staff have an updated list of
referral resources, compile a list of all
students close to the deceased, find
out if there are siblings and notify the
principals of those schools, compile a
list of all staff members that had
contact with the deceased, update and
compile a list of students who may be
at risk for suicide (11).
Avoid being unprepared.
Provide counseling and supportive
Avoid having a large assembly with
services to staff and students.
students to discuss the suicide (9).
Resources should be available at school
and off campus. Inform local mental
health agencies and crisis lines so they
can prepare to meet needs (11).
68
WHAT TO DO
WHAT NOT TO DO
Provide information about funeral and family
visitation arrangements to staff, students,
parents and community members.
Encourage the family to schedule the funeral
after school hours to facilitate student
attendance or arrange for students and staff
to be excused from school to attend the
funeral (11).
Have a memorial or funeral at the school or
fly flags at half mast. Avoid permanent
memorials on school property.
Follow-up with students identified as at risk
and provide ongoing assessment and
monitoring (11).
Stop intervention efforts after first week.
Keep to regular school hours and ensure
students follow established dismissal
procedures (1).
Cancel school or school activities.
Treat this death as you would any other.
Must find a balance between respectfully
acknowledging the death and not promoting
contagion with memorial efforts (1)
Treat it differently. This can increase stigma.
69
Suicide Contagion: process by which one
suicide death may contribute to another (1).
Suicide Cluster: A group of suicides or
suicide attempt, or both, that occurs closer
in time and space than would normally be
expected in a given community (22)
Copy Cat Suicide: When a person copies the
manner of death of another person (22).
70



Youth are more vulnerable than adults
because they may identify more readily with
the behavior and qualities of their peers (1).
Contagion is rare – only accounting for 15% of all suicide deaths annually (1).
Media coverage can contribute to
contagion. Front page stories, simplistic
explanations of suicide, graphic depictions
and printing photos of the victim can be
contributing factors (22).
71




Avoiding any sensationalizing, romanticizing or
glorification of the suicide or the victim (22).
Remember anniversary dates can also be a time of
increased risk (22).
Encourage students to get involved with living
memorials which may help prevent other suicide
deaths (22).
Refer to lists that should be made (noted on
postvention steps-slide 56) and follow up with
these students.
72
 Opportunities
for staff to talk to
someone they trust in the event of
a school crisis is essential.
 Resources should be given to staff
for counseling.
 Find self-care opportunities to
manage stress and restore
balance.
73
Role Play
&
Case Studies
74








American Association of Suicideology – www.suicideology.org
American Foundation for Suicide Prevention – www.afsp.org
Centers for Disease Control – www.cdc.gov
Mental Health America of Texas – www.mhatexas.org
National Institute for Mental Health – www.nimh.nih.gov
Substance Abuse and Mental Health Services Administration –
www.samhsa.gov
Suicide Prevention Resource Center – www.sprc.org
Texas Department of State Health Services –
www.dshs.state.tx.us
75
Free Toolkits for Schools:
1.Youth Suicide Prevention School-Based Guide.
http://theguide.fmhi.usf.edu/
2. Suicide Prevention and Postvention: Toolkit for Texas
Communities. www.texassuicideprevention.org
3. After a Suicide: A Toolkit for Schools 2011.
www.afsp.org and www.sprc.org.
4. The Trevor Survival Kit.
http://www.thetrevorproject.org/survivalkit
76
Hotlines:
1. Denton County MHMR - 24 Hour Crisis
Hotline – 1-800- 762-0157 or TTY – 1800-269-6233
2. National Suicide Prevention Lifeline – 1800-273-TALK (8255) or TTY 1-800-7994889
3. Girls and Boys Town National Hotline – 1800-448-3000 or TTY 1-800-448-1833
4. The Trevor Lifeline – 1-866-488-7386
77
1. After a Suicide Toolkit 2011: American Foundation for Suicide Prevention
2.
3.
4.
5.
6.
7.
and Suicide Prevention Resource Center: p.11, 35, 40-41, 43
American Association of Suicideology – www.suicideology.org
American Foundation for Suicide Prevention – www.afsp.org
Borowsky, I.W., Ireland, M., Resnick, M.D. (2001) Adolescent suicide
attempts: Risks and protectors. Pediatrics, 107(3), 485–493.
Brent, D.A. (1995). Risk factors for adolescent suicide and suicidal
behavior: Mental and substance abuse disorders, family environmental
factors and life stress. Suicide and Life-Threatening Behavior, 25, 52–63.
Centers for Disease Control and Prevention. Youth Risk Behavior
Surveillance—United States, 2009. Surveillance Summaries, June 4. MMWR
2010; 59 (No. SS-5).
Centers for Disease Control and Prevention, National Center For
Injury Prevention and Control. Web-based Injury Statistics Query
and Reporting System (WISQARS)[online]. Available from
www.cdc.gov/ncipc/wisqars.
78
8. Centers for Disease Control and Prevention, 2007.
http//webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html.
9. Centers for Disease Control and Prevention. Youth Risk Behavior
Surveillance—United States, 2005.
10. D’Augelli AR - Clinical Child Psychiatry and Psychology , 2002.
11. Doan, J., Roggenbaum, S., & Lazear, K. (2003). Youth Suicide prevention
school based guide – Issue Brief 3a: Risk Factors: Risk and Protective
Factors, and Warning Signs. Tampa, FL: Department of Child and Family
Studies, Division of State and Local Support Louis de la Parte Florida Mental
Health Institute, University of South Florida. (FMHI Series Publication ( #2183a,4, 6c)
12. Gould, M.S., Kramer, R.A. (2001). Youth suicide prevention. Suicide and
Life Threatening Behavior, 31, 6–31.
13. Grossman AH, D’Augelli AR - Suicide and Life Threatening Behavior , 2007.
79
14. Jennifer Wyatt Kaminski, Xiangming Fang, Victimization by Peers and
Adolescent Suicide in Three US Samples, The Journal of Pediatrics, In Press,
Corrected Proof, Available online 19 July 2009, ISSN 0022-3476, DOI:
10.1016/j.jpeds.2009.04.061
15. King, K.A. (1999). Fifteen prevalent myths about adolescent suicide. Journal
of School Health, 69 (4), 159–161.
16. Kirk, W.G. (1993). Adolescent suicide: A school based approach to
assessment and intervention. Champain, IL: Research Press.
17. Lester, D. (2000). Suicide prevention: Resources for the millennium. Ann
Arbor, MI: Sheridan Books.
18. Massachusetts Youth Risk Survey, 2007.
19. Moscicki, E. (1999). Epidemiology of Suicide. In D.G. Jacobs (ed), The
Harvard Medical School Guide to Suicide Assessment and Intervention. San
Francisco: Jossey-Bass Publishing 1999:40–51.
80
20. O’Carroll, P.W., Potter, L.B., Mercy, J.A. (1994). Programs for the prevention
of suicide among adolescents and young adults. MMWR CDC Surveillance
Summary 43 (RR-6)1–7.
21. Ryan C, Huebner D, et al – Peds, 2009;123(1):346-352)
22. Suicide Prevention and Postvention Toolkit for Texas Communities:
p.71&78
23. Tierney, R., Ramsay, R., Tanney, B., Lang, W. (1991). Comprehensive school
suicide prevention programs. In Leenaars, A.A., Wenkstern, S. (Eds.) Suicide
Prevention in Schools. New York:Hemishere Publishing Corporation
24. Western Interstate Commission for Higher Education (WICHE) and
Suicide Prevention Resource Center (SPRC). (2009) Suicide Prevention
Toolkit for Rural Primary Care. A Primer for Primary Care Providers. Boulder,
Colorado: Western Interstate Commission for Higher Education.
25. Zenere, F.J. & Lazarus, P. J. (1997). The decline of youth suicidal behavior in
an urban, multicultural public school system following the introduction of a
suicide prevention and intervention program. Suicide and Life-Threatening
Behavior, 27(4), 387–403.
81
Phyllis Finley, B.A., QMHP, QMRP
MCOT Community Liaison
(940) 565-5295
phyllis@dentonmhmr.org
Denton Outpatient Clinic
2519 Scripture
P.O. Box 2346
Denton, TX 76202
Main – (940) 381-5000
dentonmhmr.org
Our Mission:
To enhance the quality of life for
the persons we serve and
their families
82