Assessing Suicide Risk

Recognizing Distress Signals in our StudentsCampus Assessment, Response, and Evaluation (CARE) TeamProfessional Development DayOctober 18, 2013Campus Assessment, Response and Evaluation (CARE) TeamWhat we do:The mission of the Campus Assessment, Response and Evaluation (CARE) Team is to promote student success and enhance campus-wide communication regarding specific behavioral problems that may involve threats to the safety and well-being of the campus community.

299-TALKcare@mclennan.eduWho we areDr. Drew CanhamPhyllis BlackwoodPaul GonzalesClaudette Jackson

Larry RadkeJoshua RieffShelly Rogers-SharerJessica SheltonStudents in DistressCampus crime and violence statistics are relatively stableAwareness has increased greatlyThere have been reported increases in students with psychological issues and students on psychotropic medicationStudents in distress are at risk for developing:Academic and social difficulties Family and vocational strugglesDepression and anxietyViolence against othersSuicidal ideation Most of our research for this presentation focuses on suicidal students, but many of the warning signs are the sameBottom line-if you notice changes in a student or have a gut feeling that something isnt right, seek helpMost campus violence is planned and there are warning signs-not they just snappedSuicide StatisticsFacts About SuicideSuicide is the 11th leading cause of death in the U.S. (roughly 32,000 each year)Females attempt suicide more than males, while more males complete the act than femalesThe rate of suicide attempts for females is 3 times that of malesThe rate of suicide completion for males is 4 times that of womenThis is due to the fact that males use more lethal means (guns, hanging, etc.) than women (overdosing, suffocation, etc.)

Suicide Among Our YouthSuicide is the third leading cause of death for people ages 15-24There are 11.5 youth suicides every daySomeone under the age of 24 completes suicide every two hours and five minutes in our country18-24 year-olds attempt suicide more frequently than people in any other age groupThe rate of youth suicide increased more than 200% from the 1950s to the late 1970s, where it has remained

Suicide Among College StudentsThere are roughly 1,000 suicides on college campuses each yearAfter accidents, suicide is the leading cause of death for college students (7.5 per 100,000)1 in 10 college students has seriously considered suicide Of these, 95% reported feeling so sad that they couldnt function during at least one point in the last year94% reported feelings of hopelessness1 in 12 students has planned how they would attempt suicide2000 survey of 1,600 college students:1.5% had made a previous suicide attempt50% reported feeling very sad in the last year, 33% said they had been hopeless, and 22% said they had been so depressed they couldnt functionOnly 6% of males and 13% of females had been diagnosed with depression

Mental Health on College CampusesWhy are college students at risk?Students are facing normal developmental milestones at this age (individuation, independence, identity formation, etc.)They also face financial stress, academic and social competition, and the pressure to succeedStudents have to adjust to the differences between high school and collegeStudents face these challenges on an unfamiliar campus, perhaps away from their regular support networkImprovements in psychotropic medication make it possible for people with a severe mental illness to attend collegeMore students can attend college now versus 20 years ago because of increases in financial aid availability

Special Populations IssuesNon-traditional students face the added stress of having jobs and/or family, plus the feeling of not fitting inReturning to school is also considered a major life stressorInternational students may experience increased stress because of cultural differences between themselves and their classmates, as well as financial difficultiesLack of familial support exacerbates the problemLGBTQ students tend to experience increased depression and isolationStudents with a pre-existing mental health condition, or those who develop a mental health condition while on campus, are at an increased risk of developing suicidal ideationAmong these, males, students under 21, and Asian and Hispanic students face a higher risk

Support on CampusCommunity and 2-year colleges traditionally have fewer support services availableOnly 20% of college students surveyed said they would seek help at their colleges Counseling CenterFaculty and staff typically have the most regular contact with students, and certain assignments may provide faculty with insights into a students way of thinkingThis means college employees need to know when to refer a student for help, and to whom they should refer them

Signs & Symptoms of Distressed StudentsHelping Someone in CrisisSuicide IS preventableALL threats of suicide must be taken seriouslyMost students who are suicidal demonstrate warning signsWe need to know what to look for and how to respondMost suicidal individuals want to live but are unable to see how their current situation can improveTALKING TO SOMEONE ABOUT SUICIDE DOES NOT CAUSE THEM TO BECOME SUICIDALWhat to Look For:*Many of these symptoms can also apply to students who are not suicidal but still need to be referred for assistanceLack of future goalsGiving away possessionsSadness, hopelessness, stressDepressionSleep disturbance (too much sleep or too little), fatigueAppetite change (eating too much or too little)Extreme or prolonged sadnessLack of pleasure in things that used to please themFeelings of worthlessnessPoor concentration and decision-makingPrevious diagnoses (especially Borderline Personality Disorder, Major Depressive Disorder, or Dysthymic Disorder)

What to Look For continued:Indirect verbal cues such as It wont matter, or No one cares.Disheveled appearanceRage or anger that is inappropriate or irrationalSudden change in attendance, class participation, or quality of workWithdrawing from normal activities or social interactionsChanges in their usual behaviorCausing disruptions in the living or learning environment Talking or writing about suicideDirectly threatening suicide

Responding EffectivelyHow to Respond to the StudentStay calm and slow down the processMaintain personal space and use caution in touching themMaintain intermittent eye contactAvoid excessive familiarity Minimize distractions Pay attention to their nonverbal communication Listen, even to speech that might make you uncomfortableBe direct and talk openlyBe respectful and non-judgmental

How to Respond to the StudentGive firm, clear directions and set reasonable limitsGive limited choicesFocus on problem-solvingOffer empathy instead of sympathyBe truthfulTry not to show your shock or upset feelingsTell them that help is available and alternatives existRemove means to attempt suicide if possibleEngage the person in future talk (looking forward to positive things in that persons future)Offer to be another source of support and encouragement-express concernEncourage the student to exercise, eat right, sleep 7-8 hours daily, and follow any advice given by their doctor or therapist

DO NOT:leave them alone, even to call usrefer to their family as motivation to stay alivedare them to do itmake decisions for themencourage venting or disordered thinkingask whydebate valuespromise to keep the conversation a secretoverreact make accusationsbe hostile or threateningget into a power struggle

Who to Notify or Call For HelpIf the situation is urgent, call 8911 to alert Campus SecurityIf you are not comfortable calling security, call us; we can call for youIf you suspect a student is suicidal, get helpYou are NOT responsible for diagnosing or treating the student, just ensuring that someone who can help is aware of the situationRefer to Counseling Services (see Campus Response Guide)Encourage them to come see us We can come to your location if the student wont agree to come to us

What about confidentiality?FERPA allows disclosure of information in emergency situations when the information is necessary to protect the health or safety of some personAdditionally, FERPA applies to recordsnot your observations about a student or a conversation the student has with youYou are not bound by confidentiality in the same way a licensed mental health professional would beAt the end of the day, are you more comfortable with keeping the student happy, or keeping the student safe (even if theyre angry with you)

Students with general counseling concerns after hours can call Counseling Services and leave a voicemailIf there is an urgent counseling need that occurs during work hours and Counseling Services is closed or unreachable, call Student Development at 8614If there is an urgent counseling need after 6pm, call 8911Be sure to document what the student said, how you intervened, and where you referred themCounseling ServicesWellness and Fitness BuildingRoom 101299-8210

Decision Tree for Students in DistressCulture of ReportingLet go of any hesitancy Its not pressing chargesThe key concept is data collectionA relatively manageable problem in your class may play a role in a larger issueIf you have a question about it, just file a report. We pledge to be diligent in sorting them out. If you see something, say something.

www.mclennan.edu/reportit

Following-UpDont assume that just because you gave a student our number, that they calledAccompany the student to our office, if possibleFollow up with the student and ask them how they are doingBe sure you do this privately We wont be able to provide confidential information to you unless the student approvesDocument what happened and how you responded by filling out a CARE Team report at mclennan.edu/reportitTake care of yourselfDuring your interactions with the student, monitor your own reactions and stress levelsBe prepared to feel mentally and physically exhaustedTalk with someone if you need to process what happened

ScenariosJack is a student in your class. He emails you at 2am to apologize in advance for missing tomorrows test. He says hes been dealing with a lot of stuff and took a few too many pills, if you know what I mean. What do you do?Jill is a student youve advised. She emails you that shes thinking about dropping out of school. She says she is thinking about ending it all. You reply to her email but havent heard back in several hours. What do you do?REMEMBERUnless you are a licensed mental health professional, it is not your responsibility to make a clinical suicide assessmentThese tips are to help you recognize possible distressed students in order to get them to someone who can helpWe are here to answer any questions, hear your concerns, or guide you in how to respond to students you are concerned aboutREPORT IT!!!!!!

ReferencesUnderstanding and helping the suicidal individual. (2009). Retrieved June 22, 2009, from http://www.suicidology.org Youth suicide fact sheet. (2009). Retrieved June 22, 2009, from http://www.suicidology.org Suicide in the U.S.A based on current (2006) statistics. (2009). Retrieved June 22, 2009, from http://www.suicidology.org Deisinger, G., Randazzo, M., ONeill, D., & Savage, J. (2008). The handbook for campus threat assessment & management teams. Stoneham, MA: Applied Risk Management.References, continuedLa Di Da by Asher Roth. (2009). Retrieved June 22, 2009, from http://www.halfofus.com Kadison. R., & DiGeronimo, T. F. (2004). College of the overwhelmed: The campus mental health crisis and what to do about it. San Francisco: Jossey-Bass.Mattas-Curry, L. (2000). Eight factors found in assessing suicide risk. Monitor on Psychology, 31 No. 2. Roy, L. (2009). No right to remain silent: The tragedy at Virginia Tech. New York: Harmony Books.