Intervention

Intervention of Potential Suicide or a Threat to Others

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V. Intervention with a Potential Suicide or a Threat to Others

Individuals Who May Be Suicidal

Immediate Action

In the event that a Team member has reason to believe that a person may be suicidal or represent a potential threat to others the following action is to be taken:

1. Take all comments about suicidal thoughts seriously, especially if details of a suicide plan are shared.

2. Immediately report concerns to the Team Leader.

3. Under no circumstances should an untrained person attempt to assess the severity of suicidal risk; all assessment of threats, attempts, or other risk factors must be left to the appropriate professionals.

Response to a Suicide Attempt Not Occurring at School

When a individual becomes aware that someone has attempted suicide, the individual must protect that person’s right to privacy. Should a someone notify someone about a suicide attempt, the person should be referred to appropriate community agencies for support services. Staff response should be focused on quelling the spread of rumors and minimizing the fears of fellow member and staff. As opposed to convening a Crisis Response Team meeting and alerting the student body, any services provided to the person who attempted suicide must be kept confidential and coordinated with outside service providers, such as a suicide crisis counselor or hospital emergency team.

A Suicide Attempt Becomes A Crisis To Be Managed By Staff Only When One Or More Of The Following Conditions Exist:

1. Rumors and myths are widespread and damaging.

2. Students witness police action or emergency services response.

3. A group of the attempt survivor’s friends are profoundly affected by the suicide attempt and request support.

When one or more of the above conditions exists, the following should be implemented:

1. Tell the person providing the information about the suicide attempt not to repeat it elsewhere.

2. If office staff members heard the report, tell them not to repeat or give out any information unless they are specifically told to do so.

3. Have the Crisis Response Team member closest to the survivor talk to the most profoundly affected friends and determine the type support they need.

4. Provide space for the identified peers to receive support services. Notify people of the services.

Reentry for a person Who Has Attempted Suicide

Efforts to respond to suicide attempts and other traumas should be focused on making the individuals return to school a comfortable one. Because families exposed to a suicide attempt experience considerable guilt and fear, they are more likely to disclose that a daughter or son has made an attempt if they know the school has a helpful, non-threatening manner of dealing with suicide.

Because a student who attempted suicide often is at greater risk for a suicide in the months following the crisis, it is extremely important to closely monitor his or her reentry into society and to maintain close contact with parents and mental health professionals working with that person.

Assuming the person will be absent from one to four weeks after a suicide attempt and possibly hospitalized in a treatment facility, our policy will follow these steps:

1. Obtain a written signed release of information. This makes it possible for confidential information to be shared between personnel and treatment providers.

2. Inform the proper authorities regarding the number of probable days of absence.

3. Maintain contact with the person to keep him/her informed of the latest, if appropriate.

4. Seek recommendations for aftercare from the therapist. If the person has been hospitalized, a Crisis Response Team member should attend the discharge meeting at the hospital.

5. The Crisis Response Team member should convey relevant non-confidential information to appropriate people regarding the aftercare plan.

6. Once the person returns, a Crisis Response Team member should maintain regular contact with him/her.

7. The authorities should maintain contact with the parents provide progress reports and other appropriate information, and be kept informed of any changes in the aftercare plan.

Myths and Facts About Suicide

Myth: People who talk about suicide don’t commit suicide.

Fact: Most people who commit suicide have given clues of some type of to one or more people. It is not safe to assume that someone talking about suicide will not attempt it; the majority of those who attempt suicide have stated their intent to someone.

Myth: Suicide happens without warning.

Fact: While explicit verbal warnings are not always given, there are clues ahead of time. The difficulty is that not everyone recognizes the signs and symptoms that would alert him/her to the possibility of suicide.

Myth: Suicidal people are fully intent on dying.

Fact: Rather than specifically wanting to die, students who attempt/commit suicide often do so simple because they have exhausted their coping skills and see no other options for relief from pain.

Myth: Once suicidal, a person is suicidal forever.

Fact: Preoccupation with suicidal thoughts is usually time-limited. Most young people who work through a suicidal crisis can go on to lead healthy lives.

Myth: Once a person attempts suicide, the humiliation and pain will prevent future attempts.

Fact: Eighty percent of persons who commit suicide have made at least one prior attempt (Hafen & Frandsen, 1986). It is critical that concerned adults and peers monitor a student who has attempted suicide for several months following the attempt. Those students who receive help for their suicidal risk before they made an attempt have a better prognosis than those who were intervened upon following an attempted suicide.

Myth: Suicidal behavior is inherited.

Fact: As with other patterns of behavior, suicide sometimes seems to run in families. However, suicide is not a genetic trait, so it is not inherited. What can appear to be a family trait of suicide may be because family members share a common emotional environment and often adopt similar methods of coping. In a family where someone has committed suicide, suicide may be viewed as acceptable in times of distress.

Myth: Suicide occurs more often among the wealthy.

Fact: Suicide knows no socioeconomic boundaries.

Myth: People who attempt or commit suicide are mentally ill/psychotic.

Fact: Many suicidal persons historically have had difficulty in working through problems. Other people who attempt or commit suicide choose it as an option when their previously successful means of coping are not effective, and they are unable to otherwise stop the pain they are experiencing. A history of mental illness does not increase the risk of suicide.

Myth: Talking about suicide can encourage a person to attempt it.

Fact: On the contrary, initiating a discussion of suicidal feelings may give a suicidal adolescent permission to talk about the pain she/he is experiencing and, by so doing, provide significant relief. It is highly unlikely that discussing suicide would influence a non-suicidal person to become preoccupied with the idea.

Myth: People who attempt suicide just want attention.

Fact: Suicide should be considered a "cry for help." Persons overwhelmed by pain may be unable to let others know they need help, and suicide may seem the bet way to relieve the pain. Suicidal behavior may be a desperate move to reach out for much needed help.

Myth: Suicide is most likely to occur at night as well as over the holiday season.

Fact: Suicides can occur at any time, regardless of season, time of day or night, weather or holidays. Childhood and adolescent suicides, however, are most likely to occur in the spring, and second most likely to occur in the fall. Most childhood and adolescent suicides occur at home on weekends or between the hours of 3 p.m. and midnight (Eyeman, 1987; Indiana State Board of Health, 1985).

Myth: When depression lifts, there is no longer danger of suicide.

Fact: This is a dangerous misconception. The lifting of depression often accompanies the development of a suicide plan and the final decision to commit suicide. If the improvement in mood is sudden and circumstances have not changed, the risk of suicide remains high.

(Source: Association of California School Administrators)

Students Who May Represent a Potential Threat to Others

Immediate Steps

In the event that a Team member has reason to believe that a person may represent a potential threat to others, the actions listed below are to be taken. These steps apply only to situations in which the person is presenting no immediate threat.

1. Take all comments about doing harm to others seriously, especially if details about how the acts are to be carried out are shared.

2. Immediately report concerns to an administrator.

3. Under no circumstances should an untrained person attempt to assess the severity of the risk; all assessment of threats, attempts, or other risk factors must be left to the appropriate professionals.

NOTE: It is important to avoid inappropriately labeling or stigmatizing individuals because they appear to fit a specific profile or set of early warning indicators. It’s okay to be worried about a individual, but it’s not okay to overreact and jump to conclusions.

Early Warning Signs

It is not always possible to predict behavior that will lead to violence. However, educators and parents—and sometimes other individuals—can recognize certain early warning signs. In some situations, different combinations of events, behaviors, and emotions may lead to aggressive rage or violent behavior toward self or others. A good rule of thumb is to assume that these warning signs, especially when they are presented in combination, indicate a need for further analysis to determine an appropriate intervention.

We know from research that most children who become violent toward self or others feel rejected and psychologically victimized. In most cases, children exhibit aggressive behavior early in life and, if not provided support, will continue a progressive developmental pattern toward severe aggression or violence. However, research also shows that when children have a positive, meaningful connection to an adult — whether it be at home, in school, or in the community — the potential for violence is reduced significantly.

None of these signs alone is sufficient for predicting aggression and violence. Moreover, it is inappropriate — and potentially harmful — to use the early warning signs as a checklist against which to match individual children. Rather, the early warning signs are offered only as an aid in identifying and referring children who may need help. Communities must ensure that peoples only use the early warning signs for identification and referral purposes — only trained professionals should make diagnoses in consultation.

The following early warning signs are presented with the following qualifications. They are not equally significant and they are not presented in order of seriousness. The early warning signs include:

• Social withdrawal. In some situations, gradual and eventually complete withdrawal from social contacts can be an important indicator of a troubled person. The withdrawal often stems from feelings of depression, rejection, persecution, unworthiness, and lack of confidence. It also can stem from physical, mental and spiritual abuse and fear of re-victimization.

• Excessive feelings of isolation and being alone. Research has shown that the majority of people who are isolated and appear to be friendless are not violent. In fact, these feelings are sometimes characteristic of people who may be troubled, withdrawn, or have internal issues that hinder development of social affiliations. However, research also has shown that in some cases feelings of isolation and not having friends are associated with people who behave aggressively and violently.

• Excessive feelings of rejection. In the process of growing up, and in the course of adolescent development, many people experience emotionally painful rejection. People who are troubled often are isolated from their mentally healthy or unhealthy peers. Their responses to rejection will depend on many background factors. Without support, they may be at risk of expressing their emotional distress in negative ways—including violence. Some aggressive people who are rejected by non-aggressive peers seek out aggressive friends who, in turn, reinforce their violent tendencies.

• Being a victim of violence. Individuals who are victims of violence—including physical or sexual abuse—in the community, at school, or at home are sometimes at risk themselves of becoming violent toward themselves or others.

• Feelings of being picked on and persecuted. The person who feels constantly picked on, teased, bullied, singled out for ridicule, and humiliated at home, work or at school may initially withdraw socially. If not given adequate support in addressing these feelings, some individuals may vent them in inappropriate ways — including possible aggression or violence.

• Low school interest and poor academic performance. Poor school achievement can be the result of many factors. It is important to consider whether there is a drastic change in performance and/or poor performance becomes a chronic condition that limits the person's capacity to learn. In some situations—such as when the low achiever feels frustrated, unworthy, chastised, and denigrated—acting out and aggressive behaviors may occur. It is important to assess the emotional and cognitive reasons for the academic performance change to determine the true nature of the problem.

• Expression of violence in writings and drawings. Individuals often express their thoughts, feelings, desires, and intentions in their drawings and in stories, poetry, and other written expressive forms. Many individuals produce work about violent themes that for the most part is harmless when taken in context. However, an over representation of violence in writings and drawings that is directed at specific individuals (family members, peers, other adults) consistently over time, may signal emotional problems and the potential for violence. Because there is a real danger in misdiagnosing such a sign, it is important to seek the guidance of a qualified professional—such as a psychologist, counselor, or other mental health specialist—to determine its meaning.

• Uncontrolled anger. Everyone gets angry; anger is a natural emotion. However, anger that is expressed frequently and intensely in response to minor irritants may signal potential violent behavior toward self or others.

• Patterns of impulsive and chronic hitting, intimidating, and bullying behaviors. Individuals often engage in acts of shoving and mild aggression. However, some mildly aggressive behaviors such as constant hitting and bullying of others that occur early in in there lives, if left unattended, might later escalate into more serious behaviors.

• History of discipline problems. Chronic behavior and disciplinary problems both in work, school and at home may suggest that underlying emotional needs are not being met. These unmet needs may be manifested in acting out and aggressive behaviors. These problems may set the stage for the individual to violate norms and rules, defy authority, disengage from activities and engage in aggressive behaviors with other adults.

• Past history of violent and aggressive behavior. Unless provided with support and counseling, an individual who has a history of aggressive or violent behavior is likely to repeat those behaviors. Aggressive and violent acts may be directed toward other individuals, be expressed in cruelty to animals, or include fire setting. Individuals who show an early pattern of antisocial behavior frequently and across multiple settings are particularly at risk for future aggressive and antisocial behavior. Similarly, individuals who engage in overt behaviors such as bullying, generalized aggression and defiance, and covert behaviors such as stealing, vandalism, lying, cheating, and fire setting also are at risk for more serious aggressive behavior. Research suggests that age of onset may be a key factor in interpreting early warning signs. For example, individuals who engage in aggression and drug abuse at an early age (before age 12) are more likely to show violence later on than are individuals who begin such behavior at an older age. In the presence of such signs it is important to review the individual history with behavioral experts and seek parents’ observations and insights.

• Intolerance for differences and prejudicial attitudes. All individuals have likes and dislikes. However, an intense prejudice toward others based on racial, ethnic, religious, language, gender, sexual orientation, ability, and physical appearance — when coupled with other factors — may lead to violent assaults against those who are perceived to be different. Membership in hate groups or the willingness to victimize individuals with disabilities or health problems should be treated as early warning signs.

• Drug use and alcohol use. Apart from being unhealthy behaviors, drug use and alcohol use reduces self-control and exposes individual to violence, either as perpetrators, as victims, or both.

• Affiliation with gangs. Gangs that support anti-social values and behaviors — including extortion, intimidation, and acts of violence toward other students — cause fear and stress among other students. Individuals who are influenced by these groups — those who emulate and copy their behavior, as well as those who become affiliated with them — may adopt these values and act in violent or aggressive ways in certain situations. Gang-related violence and turf battles are common occurrences tied to the use of drugs that often result in injury and/or death.

• Inappropriate access to, possession of, and use of firearms. Individuals who inappropriately possess or have access to firearms can have an increased risk for violence. Research shows that such youngsters also have a higher probability of becoming victims. Families can reduce inappropriate access and use by restricting, monitoring, and supervising Individuals access to firearms and other weapons. Individuals who have a history of aggression, impulsiveness, or other emotional problems should not have access to firearms and other weapons.

• Serious threats of violence. Idle threats are a common response to frustration. Alternatively, one of the most reliable indicators that a individual is likely to commit a dangerous act toward self or others is a detailed and specific threat to use violence. Recent incidents across the country clearly indicate that threats to commit violence against oneself or others should be taken very seriously. Steps must be taken to understand the nature of these threats and to prevent them from being carried out.

(Adapted from Source: Early Warning, Timely Response: A Guide to Safe Schools.)

Crisis Management Plan Table of Contents
Alan Scott's Research Homepage	Crisis Management Plan	Crisis Response Plan	Critical Incident/Emergency Management
Intervention of Potential Suicide or Threat to Others	Communications	Crisis Management Guide	Maps, Phone Numbers and Appendices