Students Struggling With Suicide

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The senior vice president of research at the American Foundation for Suicide Prevention offers thoughts on suicide and students.

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Q&A

Children and young adults may have a difficult time during the back-to-school season, particularly if they experience suicidal thoughts or suicidal ideation. Psychiatric Times sat down with Jill Harkavy-Friedman, PhD, senior vice president of research at the American Foundation for Suicide Prevention, to examine the complex topic of suicide in young students.

PT: What issues might arise for students struggling with suicidal ideation as they head back to school?

Harkavy-Friedman: Returning to school can be a source of mixed emotions for any student. It is a complex time for students who have been struggling with suicidal ideation during the summer. Returning to school can increase stress, exacerbate concerns about feeling stigmatized or not belonging, and lead to difficulty connecting with their peers. In order to support students, help them take care of basics such as sleep, diet, exercise, and hydration. It is a good time to have open, nonjudgmental conversations about their thoughts and feelings and practice ways to manage discomfort.

PT: What suicide resources should patients/families be aware of?

Harkavy-Friedman: 988 by phone, text, or online is the emergency contact if there is a crisis. Talking with a trained counselor at 988 can reduce distress, thereby helping individuals access their coping capacity to get further help. Counselors with 988 can also contact mobile crisis and other local crisis services as well as refer callers to local mental health care. Family members and other supports can also contact 988 for assistance with helping someone in distress. Other mental health resources can be found at https://afsp.org/find-a-mental-health-professional/.

I would also recommend #RealConvo (https://talkawaythedark.afsp.org/#convos) and Seizetheawkward.org. Parents can learn more about what they should know from our website here: https://afsp.org/teens-and-suicide-what-parents-should-know/

PT: What can clinicians do to tamp down on this “epidemic” of suicides?

Harkavy-Friedman: Note: The use of the term epidemic is not very helpful or accurate and we typically do not use it. It raises concern and stress without offering solutions and makes it sound like everyone is at risk when, in fact, while many think about suicide, fewer make suicide attempts and even fewer will die by suicide. Most individuals who think about suicide will not act on those thoughts and 90% those who make a suicide attempt do not go on to die by suicide.1 We want to normalize talking about mental health and suicide and yet make it clear when you see or hear something take it seriously.

Clinicians can help individuals who are thinking about or at risk for suicide by learning about risk factors and warning signs, asking directly about suicidal thoughts and behaviors and getting training on effective clinical interventions such as safety planning, dialectical behavior therapy, cognitive behavior therapy for suicide prevention, and attachment-based family therapy. Gaining comfort with discussing suicidal thoughts can decrease distress so that patients can work to develop skills for managing suicidal thoughts and behavior and improving their life. A clinician can develop a plan for suicide prevention in their practice rather than sending patients to emergency departments when they mention that they are thinking about taking their life. Conduct an in-depth assessment collaboratively with the patient and their supports to set up a course of treatment that includes emergency actions.

PT: Do you think having a mental health clinician in every school help?

Harkavy-Friedman: Having a mental health professional in schools has been shown to be an effective way to support students, teachers, and families. Research shows that connection to school can reduce risk for suicidal thoughts and behaviors.2-4 When services are in place in schools, research shows they will be used by students. Advantages include more accessible care, stigma reduction, support for teachers and families, and better school performance. This type of upstream approach to prevention has been shown to reduce later suicide rates.

Dr Harkavy-Friedman is senior vice president of research at the American Foundation for Suicide Prevention.

References

1. Owens D, Horrocks J, House A. Fatal and non-fatal repetition of self-harm: systematic review. Br J Psychiatry. 2002;181:193-199.

2. Duong MT, Bruns EJ, Lee K, et al. Rates of mental health service utilization by children and adolescents in schools and other common service settings: a systematic review and meta-analysis. Adm Policy Ment Health. 2021;48(3):420-439.

3. Hoover S, Bostic J. Schools as a vital component of the child and adolescent mental health system. Psychiatr Serv. 2021;72(1):37-48.

4. Marraccini ME, Brier ZMF. School connectedness and suicidal thoughts and behaviors: a systematic meta-analysis. Sch Psychol Q. 2017;32(1):5-21.

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