Principals Can Help Prevent Suicide
Topics: Health and Wellness
School personnel have a legal and ethical responsibility to recognize and respond to suicidal thinking and behavior. Schools must have clear policies and procedures for what to do, as should trained school-employed mental health professionals and crisis response teams. Although many suicidal children and adolescents do not self-refer, most show some warning signs. Never ignore these signs. Suicide prevention should be an integral component of a multitiered system of mental health and safety supports.
Assemble a Crisis Team
A trained school safety and crisis response team is essential to being able to identify and intervene effectively with students who are at risk of suicidal behavior. At a minimum, the team should include an administrator, a school-employed mental health professional, school security personnel, and other appropriate school personnel. Each crisis response team member needs to have clearly defined roles and responsibilities.
The crisis response team is responsible for developing and implementing suicide risk assessment, intervention, and postvention policies and procedures. Sometimes these policies are developed at the district level by a district crisis response team.
The crisis response team should assign one or more individuals to be a “designated reporter” who receives and acts upon all reports from teachers, other staff, and students about students who might be suicidal. This individual should be a school-employed mental health professional (e.g., school psychologist, counselor, nurse, or social worker).
All school crisis response teams should have a representative from local law enforcement. If a student resists, becomes combative, or attempts to flee, assistance from law enforcement is essential. In some jurisdictions, law enforcement can also help obtain a 72-hour hold that places the youth in protective custody for psychiatric observation and treatment. In other jurisdictions, involving the community mental health center or child protective services and/or calling 911 is required if the youth needs to be placed in protective custody and parents are unable to safely transport their child or are uncooperative. It is important to know the procedures for your jurisdiction.
All staff should receive training annually on the warning signs and referral procedures for students who display signs of suicidal thinking and behavior. Students should also receive instruction about risk factors, warning signs, and ways to get help for themselves or a friend. This training can be part of the curriculum or a comprehensive suicide prevention program, but it should be delivered by qualified, credentialed educators.
Identification and Intervention
Early identification and intervention are critical to preventing suicidal behavior. When school staff become aware of a student exhibiting potentially suicidal behavior, they should immediately escort the child to a member of the school’s crisis response team (i.e., the “designated reporter”) for a suicide risk assessment. They should not send the student on their own. If the appropriate staff is not available, call 911.
Typically, it is best to inform the student what you are going to do every step of the way. Solicit the student’s assistance where appropriate. Under no circumstances should the student be allowed to leave school or be alone (even in the restroom). Reassure and supervise the student until a 24/7 caregiving resource (e.g., parent, mental health professional, or law enforcement representative) can assume responsibility.
Designated members of the school crisis team should conduct a suicide risk assessment. The purpose of the assessment is to determine the level of risk and to identify the most appropriate actions to ensure the immediate and long-term safety and well-being of the student. This should be done by a team that includes a school-employed mental health professional. (See NASP’s handout on threat assessment for guidance on this topic: bit.ly/3U0crfy.)
Early identification and intervention are critical to preventing suicidal behavior.
Caregiver notification is a vital part of suicide prevention. The appropriate caregiver(s) must always be contacted when signs of suicidal thinking and behavior are observed. Typically this is the student’s parent(s), but protective services should be contacted when child abuse is suspected. Even if a child is judged to be at low risk for suicidal behavior, schools might ask caregivers to sign a form to indicate that relevant information has been provided. Regardless, all caregiver notifications must be documented. Caregivers also provide critical information in determining level of risk. Whether a student is in imminent danger or not, it is strongly recommended that lethal means (e.g., guns, poisons, medications, and sharp objects) are removed or made inaccessible.
Refer the student to community services if warranted. Suicidal thinking and behaviors can also occur outside of school hours, so referral options to 24-hour community-based services should be identified in advance. It is best to obtain a release from the primary caregiver to facilitate the sharing of information between the school and community agency, and it is highly recommended that the school contact the agency to share critical information. School districts have an obligation to suggest agencies that are nonproprietary or offer a sliding scale of fees.
Help the student develop a safety plan. Generally speaking, no-suicide contracts have been shown to be ineffective and are no longer recommended. However, helping the student develop a written list of coping strategies and sources of support that can be of assistance when he or she is having thoughts of suicide (i.e., a safety plan) is recommended. Suicide prevention hotlines (e.g., 800-273-TALK) and the app MY3 (my3app.org) can be helpful elements of such a plan.
Schools are legally responsible for documenting every step in the assessment and intervention process. Such documentation ensures that protocols are followed. Every school district should develop a documentation form for support personnel and crisis response team members to record their suicide intervention actions and caregiver communication. Student information must be kept confidential, but there are exceptions to FERPA when safety is of concern. Staff responsible for the safety and welfare of the student should be provided with the information necessary to work with the student and preserve their safety. School staff members do not need clinical information about the student or a detailed history of his or her suicidal risk or behavior. Discussion among staff should be restricted to the student’s treatment and support needs.
Excerpted with permission from “Preventing Suicide: Guidelines for Administrators and Crisis Teams,” published by National Association of School Psychologists. See the full NASP guidance at nasponline.org.