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Preventing Student Suicide with Just a Few Simple Questions

Suicide among children and teens is shockingly on the rise. In the wake of each tragedy, parents, peers, and educators are filled with devastation and regret. Spending so much time with children, teachers often feel guilty that they didn’t realize their student was suicidal. Other times, they sensed something was wrong but weren’t sure how to effectively intervene. So how can teachers determine if their students are at risk for suicide, and what can they do about it?

Learning these simple steps could help you save a student’s life:

1. Separate suicide and NSSI

One of the obstacles in providing proper interventions is educators not grasping the difference between suicidal behavior and non-suicidal self-injury (NSSI). Both are serious and require intervention, but the response for suicidality is different than for NSSI. Properly identifying a student’s behaviors is an important first step in getting them the right help. A few key characteristics of the two include:

Suicidal behavior/ideation:

  • The person has some intention of dying

  • They know that their behavior could result in death

  • May seek the most painless way to do it

NSSI:

  • Has no intention of dying

  • Does not believe their actions could result in death

  • Seeks physical pain to escape emotional pain

  • NSSI has 3 possible functions:

    • To obtain relief from a negative feeling or cognitive state
      e.g. stress, worry thoughts, loneliness, emptiness

    • To resolve interpersonal conflict
      e.g. family arguments, divorce, sibling rivalry, peer conflict

    • To induce a positive feeling state
      e.g. euphoria, decrease numbness

For an in-depth look at NSSI and what to do about it, click here

2. Explore the C-SSRS

The Columbia-Suicide Severity Rating Scale (C-SSRS) was developed to provide a simple, accurate, and effective tool that anyone can use to evaluate risk for suicide. You do not need to be a mental health professional to administer it; all it requires is asking a series of simple questions and referring them to mental health services if their answers raise any red flags.

The full C-SSRS screening tool is available in several versions.  
Below are a few quick links to commonly used versions.
Click here to access all versions of the C-SSRS.

C-SSRS for Teachers
C-SSRS for Family and Friends
C-SSRS for Teens to Talk to Friends
C-SSRS for Parents

3. Identify ideation

The first step in applying the C-SSRS is identifying ideation. If you are concerned your student may be at risk for suicide, start by asking these 2 questions:

  • “Have you wished you were dead or wished you could go to sleep and not wake up?”

  • “Have you actually had any thoughts of making yourself not alive anymore?”

4. Ask more as needed

When administering the C-SSRS, you only need to ask as many questions as it takes to determine whether your student has had suicidal ideation or behaviors. If your student answered no to both ideation questions, you can rule out ideation and jump right into the behavior questions listed in our next point. If they answered yes to either or both ideation questions, ask a few more ideation questions to gain understanding:

  • “Have you been thinking about how you might do this?”

  • “Have you had these thoughts and had some intention of acting on them?”

  • “Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?”

5. Assess for behaviors

Whether or not your student has indicated ideation, you must also ask behavioral questions. Determine whether they’ve engaged in suicidal behaviors by asking the following questions:

  • “Have you made a suicide attempt?”

  • “Have you done anything to harm yourself?”

  • “Have you done anything dangerous to where you could have died?”

6. Inquire about interruptions

Next, ask your student if there were ever times where they had attempts that were either stopped by someone interrupting them, or by them having second thoughts:

  • “Has there been a time when you started to do something to end your life but someone or something stopped you before you actually did anything?”

  • “Has there been a time when you started to do something to end your life but you stopped yourself before you actually did anything?”

7. Ask about preparatory behaviors

Even if your student has not indicated making any attempts, it’s important to find out if they’ve done anything to prepare to end their life. Examples could include collecting pills, purchasing a gun, writing a suicide note, or giving valuables away.  

  • “Have you taken any steps toward making a suicide attempt or preparing to kill yourself?”

8. Know when it’s an emergency

If your student answers yes to any questions regarding ideation, behaviors, or non-suicidal self-injury, it’s important to refer them to mental health resources. For a student to require a 911 call and/or immediate escort to emergency services, they should meet either of the following criteria:

  • Active suicidal ideation with some intent to act, without specific plan

  • Active suicidal ideation with specific plan and intent

Check out these video clips to learn how to ask C-SSRS questions:

Joanna’s example

Gabriel’s example

Andrea’s example

Click here to watch Columbia University’s C-SSRS webinar

9. Reach out and speak up

If your student’s answers have indicated suicidal ideation, suicidal behaviors, or non-suicidal self-injury, quickly share your findings with the school leadership, crisis response team, school psychologist, school counselor or other mental health professional on campus. If you’re not sure who to alert, call 911. As a preventative measure, advocate for mental health programming to be offered on campus so that all students learn healthy coping skills and become aware of available resources.

10. Host a C-SSRS training

The best way to prevent tragedy on campus is to get your faculty on the same page with effective tools that address mental health emergencies. While you don’t have to be a mental health professional to administer the C-SSRS, it’s best to complete a brief online training and receive additional in-person education from a mental health professional to fully grasp how to evaluate student answers in real-life scenarios.

Here is a listing of C-SSRS training options including pre-recorded and live webinars.  

If you represent a private school or district that would like to do an in-service teacher training, our Specialists can:

  • Visit your campus for in-person training

  • Answer questions and review key concepts of applying the C-SSRS

  • Provide realistic examples of evaluating students’ risk for self-harm

  • Help teachers prepare students for educational units or aspects of popular culture that may romanticize suicide (example: Romeo and Juliet, TV shoes depicting suicide, etc.)

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References:

The Columbia Lighthouse Project (2018). The Columbia Protocol for Your Setting. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare/#filter=.general-use.english

The Columbia Lighthouse Project (2018). Community Card for Teachers. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-Teachers-2018c.pdf

The Columbia Lighthouse Project (2018). Community Card for Friends and Family. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-2women-2018c.pdf

The Columbia Lighthouse Project (2018). Community Card for Teens. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-Teens-2018c.pdf

The Columbia Lighthouse Project (2018). Community Card for Parents. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-Parents-2018c.pdf

The Columbia Lighthouse Project (2017). C-SSRS Training. [Video webinar]. Retrieved from https://www.youtube.com/watch?v=epTDFFv3uwc&list=PLZ6DpvOfzN1kV1F_lDw9-26JifBSDlIbF&index=2&app=desktop

Shinn, M.M. (2018). Cutting & Other Self-Harm: What Every Parent Needs to Know. Psychologically Speaking. [Variations Psychology blog post].  Retrieved from https://www.variationspsychology.com/blogs/cutting-other-self-harm-what-every-parent-needs-to-know

Shinn, M.M. (2018). 8 Tips to Create a Mentally Healthy Classroom.  Psychologically Speaking. [Variations Psychology blog post].  Retrieved from https://www.variationspsychology.com/blogs/8-tips-to-create-a-mentally-healthy-classroom

Shinn. M.M. (2019). Parent’s Guide: What to do When Your Child’s Friend Dies by Suicide. Psychologically Speaking. [Variations Psychology blog post]. Retrieved from https://www.variationspsychology.com/blogs/parents-guide-what-to-do-when-your-childs-friend-dies-by-suicide

Shinn. M.M. (2019). Suicide Prevention in the School Setting. Variations Psychology, Futures Academy. [Webinar].

Posner, K.; Brent, D.; Lucas, C.; Gould, M.; Stanley, B.; Brown, G.; Fisher, P.; Zelazny, J.; Burke, A.; Oquendo, M.; Mann, J.(2008) Columbia-Suicide Severity Rating Scale (C-SSRS). The Research Foundation for Mental Hygiene, Inc. Retrieved from https://cssrs.columbia.edu/wp-content/uploads/C-SSRS_Pediatric-SLC_11.14.16.pdf

How to Cite This Blog Article:

Shinn. M.M. (2019). Preventing Suicide in Students: How 3-6 Questions Can Save Lives. Psychologically Speaking. [Variations Psychology blog post]. Retrieved from: https://www.variationspsychology.com/blogs/preventing-student-suicide-with-just-a-few-simple-questions