Children’s Service Center supports Suicide Prevention and Awareness with programs and services designed to identify risk factors and provide treatment and support for mental health and substance use disorders, including crisis intervention for related emergencies. Call 570-825-6425 for services and information or visit www.cscwv.org.

Identifying the Risk Factors

· Abrupt changes in personality

· Giving away possessions

· Previous suicide attempts

· Breaking up with a boyfriend/girlfriend

· Inability to tolerate frustration

· Use of drugs and/or alcohol

· Change in eating patterns; significant weight changes

· Unwillingness or inability to communicate

· Sexual promiscuity

· Extreme or extended boredom

· Inability to concentrate

· Accident prone (carelessness), hostile or reckless behavior

· Unusually long grief reaction

· A stressful family life

· Unusual sadness, discouragement and loneliness

· Neglect of personal appearance, lack of self esteem

· Major loss (of loved one or home, divorce, trauma, relationship)

· Running away from home or truancy from school, rebelliousness

· Withdrawal (from people, especially close friends, family or favorite activities)

· Perfectionism

· Restlessness, anxiety, stress

· Problems with school or the law

· Unexpected pregnancy

· Family history of suicide

Behavior in the Classroom

· Abrupt changes in attendance. Remain alert to excessive absenteeism in a student with a good attendance record, particularly when the change is sudden.

· Dwindling academic performance. Question any unexpected and sudden decreases in school performance. Inability to concentrate is frequently found in depressed adolescents, leading to poor school performance.

· Sudden failure to complete assignments. This may be due to a variety of factors, however, it is often seen in suicidal and depressed young people.

· Lack of interest in activities and surroundings. It is difficult to maintain surveillance over so many adolescents, but one of the first signs of a potentially suicidal adolescent is general withdrawal, disengagement and apathy.

· Changed relationships with friends and classmates. Additional evidence of personal despair may be abrupt changes in friendships and social relationships.

· Increased irritability, moodiness or aggressiveness. Depressed, stressed and potential-ly suicidal individuals demonstrate wide mood swings and unexpected displays of emotion.

· Withdrawal and displays of sadness. Some students who are seen as non-participatory

but do not cause problems in the classroom, are often overlooked.

· Death and suicidal themes evident in reading selections and written essays. These should be viewed as warning signs for teachers, particularly if it occurs on more than one occasion.

Behavior Out of the Classroom

· Neglect/apathy about personal hygiene and appearance.

· Unusual changes in eating or sleeping patterns. There may be a noticeable decrease or increase in appetite with significant weight change, insomnia or a desire to sleep all the time.

· Overt sadness and depression. The young person may often appear sad and depressed and show signs of tension and extreme anxiety.

· Acting out behavior. Behavior may include substance abuse, refusal to go to school, sexual promiscuity, running away, fighting, recklessness, purposely hurting one’s body, delinquency, preoccupation with revenge.

· Marked emotional instability. Distraught students are likely to have wide and unpredictable mood swings. Particular attention should be given to a sudden change in mood from depression to cheerfulness, as if the answer to the problem is now clear.

· Remarks indicating profound unhappiness or despair. Statements might include references to feeling constantly hassled, under stress or unable to concentrate or rest properly.

· Loss of interest in extracurricular activities.

· Giving away prized possessions. Students who do not care about the future or have decided that they will not be around are likely to give away possessions they value.

· Direct suicide threats or attempts. All suicide threats and attempts should be taken seriously. At added risk are students who have threatened or attempted suicide before. In this case, the usual inhibitions against hurting themselves have been removed.

There is a heightened risk if there has been:

A recent loss in close relationships. Losses of significant others are misfortunes that adults learn to handle. For developing adolescents, these events can be devastating and can overtax their current coping skills. Examples are death or divorce of parents, losing a close friend, breaking up with a steady, being cut from an athletic team.

Heavy use of alcohol or drugs. Students who are substance abusers tend to be at higher risk for suicide. Heavy drug and alcohol users are likely to be depressed youngsters who are seeking relief. Eventually these substances stop working and, in fact, contribute to a greater depression. These substances also contribute to compulsive behavior, which often leads to accidents and suicide.

A recent suicide in the family or of a friend. A recent suicide in the family significantly increases the suicide risk of survivors for the following reasons: a) a pervading sense that they, too, are doomed to commit suicide; b) an unbearable grief, depression and/or guilt over the loss of a loved one; c) a fear of mental illness; and d) a realization that suicide presents an optional way out of an unwelcome and painfully unhappy life.

This material was adapted from the Yellow Ribbon Suicide Prevention Program.

National Suicide Prevention Lifeline: Dial 988

National Suicide Prevention Month

#BeThe1To

#BeThe1To is the National Suicide Prevention Lifeline’s message for National Suicide Prevention Month and beyond, which helps spread the word about actions we can all take to prevent suicide. The Lifeline network and its partners are working to change the conversation from suicide to suicide prevention, to actions that can promote healing, help and give hope.

Physical distancing during COVID-19 doesn’t have to mean feeling alone. Click here to find out how to tailor each step of #BeThe1To if you cannot be there in person for someone else.

Ask

How – Asking the question “Are you thinking about suicide?” communicates that you’re open to speaking about suicide in a non-judgmental and supportive way. Asking in this direct, unbiased manner, can open the door for effective dialogue about their emotional pain and can allow everyone involved to see what next steps need to be taken. Other questions you can ask include, “How do you hurt?” and “How can I help?” Do not ever promise to keep their thoughts of suicide a secret.

The flip side of the “Ask” step is to “Listen.” Make sure you take their answers seriously and not to ignore them, especially if they indicate they are experiencing thoughts of suicide. Listening to their reasons for being in such emotional pain, as well as listening for any potential reasons they want to continue to stay alive, are both incredibly important when they are telling you what’s going on. Help them focus on their reasons for living and avoid trying to impose your reasons for them to stay alive.

Why – Studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts. In fact, studies suggest the opposite: findings suggest acknowledging and talking about suicide may in fact reduce rather than increase suicidal ideation.

Be There

How – This could mean being physically present for someone, speaking with them on the phone when you can, or any other way that shows support for the person at risk. An important aspect of this step is to make sure you follow through with the ways in which you say you’ll be able to support the person – do not commit to anything you are not willing or able to accomplish. If you are unable to be physically present with someone with thoughts of suicide, talk with them to develop some ideas for others who might be able to help as well (again, only others who are willing, able, and appropriate to be there). Listening is again very important during this step – find out what and who they believe will be the most effective sources of help.

Why – Being there for someone with thoughts of suicide is life-saving. Increasing someone’s connectedness to others and limiting their isolation (both in the short and long-term) has shown to be a protective factor against suicide. Thomas Joiner’s Interpersonal-Psychological Theory of Suicide highlights connectedness as one of its main components – specifically, a low sense of belonging. When someone experiences this state, paired with perceived burdonsomeness (arguably tied to “connectedness” through isolating behaviors and lack of a sense of purpose) and acquired capability (a lowered fear of death and habituated experiences of violence), their risk can become severely elevated.

In the Three-Step Theory (or more commonly known as the Ideation-to-Action Framework), David Klonsky and Alexis May also theorize that “connectedness” is a key protective factor, not only against suicide as a whole, but in terms of the escalation of thoughts of suicide to action. Their research has also shown connectedness acts as a buffer against hopelessness and psychological pain.

By “being there,” we have a chance to alleviate or eliminate some of these significant factors.

Keep Them Safe

graphic be the one to keep them safe

How – First of all, it’s good for everyone to be on the same page. After the “Ask” step, and you’ve determined suicide is indeed being talked about, it’s important to find out a few things to establish immediate safety. Have they already done anything to try to kill themselves before talking with you? Does the person experiencing thoughts of suicide know how they would kill themselves? Do they have a specific, detailed plan? What’s the timing for their plan? What sort of access do they have to their planned method?

Why – Knowing the answers to each of these questions can tell us a lot about the imminence and severity of danger the person is in. For instance, the more steps and pieces of a plan that are in place, the higher their severity of risk and their capability to enact their plan might be. Or if they have immediate access to a firearm and are very serious about attempting suicide, then extra steps (like calling for emergency help or driving them to an emergency department) might be necessary. The Lifeline can always act as a resource during these moments as well if you aren’t entirely sure what to do next.

The Harvard T.H. Chan School of Public Health notes that reducing a suicidal person’s access to highly lethal means (or chosen method for a suicide attempt) is an important part of suicide prevention. A number of studies have indicated that when lethal means are made less available or less deadly, suicide rates by that method decline, and frequently suicide rates overall decline. Research also shows that “method substitution” or choosing an alternate method when the original method is restricted, frequently does not happen. The myth “If someone really wants to kill themselves, they’ll find a way to do it” often does not hold true if appropriate safety measures are put into place. The Keep Them Safe step is really about showing support for someone during the times when they have thoughts of suicide by putting time and distance between the person and their chosen method, especially methods that have shown higher lethality (like firearms and medications).

Help Them Connect

graphic be the one to help them connect

How – Helping someone with thoughts of suicide connect with ongoing supports (like the Lifeline, 800-273-8255) can help them establish a safety net for those moments they find themselves in a crisis. Additional components of a safety net might be connecting them with supports and resources in their communities. Explore some of these possible supports with them – are they currently seeing a mental health professional? Have they in the past? Is this an option for them currently? Are there other mental health resources in the community that can effectively help?

One way to start helping them find ways to connect is to work with them to develop a safety plan. This can include ways for them identify if they start to experience significant, severe thoughts of suicide along with what to do in those crisis moments. A safety plan can also include a list of individuals to contact when a crisis occurs.

Why – Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifelinefound that individuals that called the National Suicide Prevention Lifeline were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by Applied Suicide Intervention Skills Training-trained counselors. These improvements were linked to ASIST-related counselor interventions, including listening without judgment, exploring reasons for living and creating a network of support.

Follow Up

How – After your initial contact with a person experiencing thoughts of suicide, and after you’ve connected them with the immediate support systems they need, make sure to follow-up with them to see how they’re doing. Leave a message, send a text, or give them a call. The follow-up step is a great time to check in with them to see if there is more you are capable of helping with or if there are things you’ve said you would do and haven’t yet had the chance to get done for the person.

Why – This type of contact can continue to increase their feelings of connectedness and share your ongoing support. There is evidence that even a simple form of reaching out, like sending a caring postcard, can potentially reduce their risk for suicide.

Studies have shown a reduction in the number of deaths by suicide when following up was involved with high risk populations after they were discharge from acute care services. Studies have also shown that brief, low cost intervention and supportive, ongoing contact may be an important part of suicide prevention. Please visit our Follow-Up Matters page for more.

Share the #BeThe1To steps in your community.  Find out how.

Working Together

Organizations across the state of Pennsylvania continue to work together to provide mental health and suicide prevention education and awareness events. Jana Marie Foundation, Garret Lee Smith Youth Suicide Prevention Grant, Prevent Suicide PA, and the Pennsylvania Network for Student Assistant Services are proud to provide this informational packet to help you build awareness and take action to prevent suicide within your community.

About Jana Marie Foundation

Jana Marie Foundation harnesses the power of creative expression and dialogue to spark conversations, build connections, and promote mental wellness among young people and their communities. The organization envisions communities working together to knock down walls and transform emotional distress into resilience and hope. Jana Marie Foundation is located in Centre County, Pennsylvania. https://janamariefoundation.org

About Garrett Lee Smith Youth Suicide Prevention Grant

The Garrett Lee Smith Youth Suicide Prevention Grant is a five-year federal SAMHSA grant awarded to the Office of Mental Health and Substance Abuse Services (OMHSAS) at the Department of Human Services. The project targets youth ages 10-24 and provides awareness, training, and screening activities to increase identification and improve continuity of care for youth at risk of suicide.

About Prevent Suicide PA

Prevent Suicide PA supports those who are affected by suicide, provides education, awareness, and understanding by collaborating with the community to prevent suicide, and reduces the stigma associated with suicide. The organization envisions having a Commonwealth where every life is valued, that everyone has the support necessary to get help when needed, and that hope and healing abounds in every person. http://preventsuicidepa.org/

About Pennsylvania Network for Student Assistant Services (PNSAS)

The mission of the Pennsylvania Network for Student Assistance Services is to provide leadership for developing a safe and drug-free environment and mental health wellness in schools and communities across the commonwealth. Barriers to learning will be removed and student academic achievement will be enhanced through collaborative prevention, intervention, and postvention services. http://pnsas.org/

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