Friday, April 18, 2014

District grappling with big increase in student suicide risk assessments

It seems to come out of the blue.

Davis High School head counselor Courtenay Tessler will be in her office with a student who needs a transcript, or help deciding which class to take or what college to apply to. Together they’ll take care of whatever it is the student needs, Tessler will sign a pass for the student to return to class, and then she’ll ask, “Is there anything else I can do for you?”

The student will pause, fidget, hem and haw for a moment, and then blurt it out:

“I’ve been thinking about killing myself.”

At that moment everything else disappears: the afternoon of counseling appointments scheduled one after another, the emails that need returning, the phone calls that were supposed to be made, the meetings to be attended. And for the next two, three, four hours, Tessler will be focused on this student in this office, asking specific questions and listening very carefully to the answers.

There is a script involved now, a suicide risk assessment interview, to gauge what this teen needs and where that help should come from. Parents need to be contacted and if the student appears to be in imminent danger, the police as well. Hospitalization may be necessary.

None of this really falls under the job description of the school counselor, said Pam Mari, director of student services for the Davis school district. But increasingly, it is what secondary school counselors like Tessler are doing.

The number of risk assessment interviews for students who may be suicidal increased in Davis schools by 81 percent over the past two years, said district crisis counselor Jen McNeil.

The district is now averaging about one such interview per school day across the secondary school sites, as well as at some elementary schools.

In April alone, there were 17 school days and 22 suicide risk assessment interviews, McNeil said.

“Many months,” she added, “the interviews now exceed the school days.”

The assessments are not about determining whether, in fact, the student is likely to attempt suicide, but about what resources and what intervention are needed.

“There is a huge space between, ‘You’re fine,’ and ‘You need to be hospitalized,’ ” McNeil explained. “It is a huge range with progressive incremental interventions.”

Determining what intervention is needed falls to the school psychologists, counselors and nurses at each school site. And the increasing need to focus on the mental and emotional health of students has changed the role of the counselor immensely, said longtime district counselor Carol Curinga, now head counselor at Da Vinci Charter Academy.

“It’s not algebra versus geometry anymore,” she said, “but should we call the hospital on a 5150?”

On the rise

The number of students in crisis has been on a steady increase the last two years, district officials said. Midway through the school year two years ago, there had been 52 suicide risk assessment interviews. By the same time this year, there had been 94, with no let-up in sight. By the time the school year ends on June 6, the number will likely be well over 150 for the year.

Tenth-graders represented the largest group of students in crisis midway through this school year — 28 percent of the total interviews — followed by ninth-graders and 12th-graders, McNeil said.

Sometimes the students seek help on their own. Others are referred by teachers, parents and even classmates, for something they’ve said, something they posted on social media, sometimes evidence that they have already tried to hurt themselves. However they end up there, the students arrive in their counselors’ offices and, more often than not, they start talking.

“Parents would be stunned to know how quickly students disclose to counselors,” Mari said.

And that, perhaps, would be the good news.

Because as concerned as district officials are over the increase in kids in crisis, they are also aware that those are just the students they know about — the ones receiving intervention at school.

Other students — or their parents — are contacting Suicide Prevention of Yolo County through its hotline after hours or on weekends, and the reason many choose that route is alarming to school district staff.

“The director of the crisis hotline said that the main reason given by parents calling in off-hours is that they didn’t want the school to know,” Mari said.

But if the schools don’t know, counselors cannot help when that child returns to campus. And if a child’s own parents are ashamed enough to hide the crisis from the school, what does that mean for the child? the counselors ask.

“It is so destablizing for the student,” Mari said.

District responds

As the magnitude of the problem became apparent early in the school year, the district took a number of steps.

Suicide prevention has long been a part of the health curriculum in the seventh and ninth grades, with Suicide Prevention providing in-class instruction and information directly to students, including teaching them how to recognize issues and warning signs in themselves as well as their friends and reminding them that it is not their job to determine if a friend is suicidal — that is a job for an adult.

Additionally, school staff receive training in warning signs and how to respond, and every few years, a parent education program is provided as well.

This year, concerned about the increase in students in crisis, Mari asked McNeil, with the assistance of a committee composed of representatives of each school, to prepare a response plan, in the event a suicide or other traumatic death happens. Research has shown that a single adolescent suicide increases the risk of additional suicides within a community and may serve as a catalyst for the development of a suicide cluster.

“It can happen anywhere, anytime,” McNeil said. “And to not be prepared does not make any sense.”

Especially, she said, “since we’ve learned so much (about) how to respond.”

Responding means not just stopping the contagion effect, but also providing the support the school and community needs to grieve and move forward. Following the Hazelden Institute’s “Lifelines” program for suicide prevention, intervention and postvention, the committee has almost completed its response plan, McNeil said, and every school will have at least one staff member on campus ready and able to put the plan into effect if needed.

They are fortunate to be led by McNeil, her colleagues said, because of her expertise specifically in the area of suicide.

“We are so fortunate to have Jen trained in this,” Curinga said. “What we knew about suicidology when I was trained is very different from today.”

What is known today, McNeil said, “is that in every classroom of 36 students, three will have had a suicide attempt and three to four will have had plans for one.”

The key, she said, “is to figure out who those young people are.”

“Suicide prevention is paying attention to who is hurting and asking them questions,” she said.

Lives are saved

That’s where staff training and awareness becomes key. Each time McNeil has met with staff at a Davis secondary school this year, the number of students referred for risk assessment interviews has increased. Some, perhaps, in the nick of time.

Three separate times this year, McNeil has received a letter from a parent thanking her for saving a student’s life.

“I’ve never gotten even one of those before,” she said.

In one case, McNeil was told that a student had had a suicide plan in place for the very day McNeil called her into the office for an assessment.

And while increased awareness among school staff may have led to an increase in risk assessment interviews, all of the school district staff and counselors interviewed for this article said there is more to it than that.

“We definitely have more kids in crisis,” Tessler said.

And it is not unique to Davis, Mari said.

“This is a national phenomenon,” she explained.

Nationally, according to the American Association of Suicidology, suicide ranks as the third leading cause of death for young people ages 15 to 19. Male youths died of suicide 4.34 times more frequently than females, though females attempt suicide more often (9.8 percent for females versus 5.8 percent for males), the association said.

Hispanic females report more suicide attempts (13.5 percent) than any other racial or ethnic group.

The majority of youths who died by suicide use firearms (44.5 percent of deaths), with suffocation the second most commonly used method (39.7 percent).

The main risk factors are mental illness and substance abuse; previous suicide attempts; firearms in the household; nonsuicidal self-injury; exposure to friends’ or family members’ suicidal behavior; and low self-esteem, according to the association.

Top triggers

And while many of these teens have underlying mental health conditions — depression, anxiety, bipolar disorder — and are under the care of professionals, McNeil said, there is usually a trigger involved as well.

The most common triggers nationally, she said, are a real or perceived loss, whether of a friendship or a family or romantic relationship, and getting into trouble with an authority figure.

That mental and emotional health tops the list of risk factors for youth suicide may explain the increase in students at risk in Davis.

According to Mari, the significant growth seen in the school district’s special education program — which now numbers more than 900 students — can be traced almost entirely to those issues.

“Virtually all of the growth in special ed is emotional disturbance,” she said. “There are simply more students who have a great deal of difficulty negotiating school. You see the visible signs of high anxiety.”

Many students also have lost the protective factors that normally would go a long way toward keeping them mentally and emotionally healthy, counselors said.

They point specifically to a loss of connectedness — both to family and at school.

According to the American Association of Suicidology, the top protective factors when it comes to youth suicide are feeling connected to family and school; reduced access to firearms; safe schools; academic achievement; and self-esteem.

And while students — with their constant texting, tweeting and posting on social media — may believe their relationships are many and strong, they are missing a critical component, counselors said.

“There’s less face time,” Mari said. “They perceive they are more connected, but they are not.”

“And the intersection between social media and mental health is astounding,” McNeil added.

On the Internet

It’s been seen in a number of different ways recently.

Last month, a Bay Area teen, Audrie Potts, committed suicide after being sexually assaulted and cyber-bullied, allegedly by several young men who posted photos of and comments about the assault online.

Three days before she killed herself, Potts posted messages on Twitter and Facebook saying, “My life is ruined now.”

A few weeks ago, staff at Holmes Junior High School learned of suicidal messages being posted on Instagram by someone who self-identified as a seventh-grader at the school. McNeil described lengthy attempts to identify who the student was — including over the course of a weekend — to no avail. Finally, the school sent a message out to all Holmes families via the listserv.

“Although we most certainly do not want to cause distress,” the message said, “because we cannot identify the origin of the account … we are advising all (seventh-grade) parents to have a conversation with their child.”

In addition to recommending that parents look at their children’s social media accounts, the message noted that, “(this) is an opportunity to discuss welfare issues (emotional and social) with your child and what are healthy versus unhealthy coping skills. It is also an opportunity to discuss social media, both the benefits and risks.”

The child was almost immediately identified upon return to school, McNeil said, and intervention began.

‘Urgent challenge’

Monitoring student use of social media, along with everything else related to student mental health, is now a regular part of the job. And Davis school counselors speak of the responsibility they feel — of going home exhausted from a day of interventions and of sleepless nights worrying about their students.

But they also know they are making a difference.

“Doing these risk assessments,” Tessler said, “we are effective. And it goes back to that connectedness. Having someone connect with them. We have seen children turn it around and get support.”

“We have a very, very urgent challenge,” Mari added. “(Counselors) are trained to handle these situations. They are prepared to do it and must do and they’re glad to do it.

“This intense work goes on every day,” she added, “and as deeply concerning as it is, they are the very best.”

However, she added, the only reason counselors are present in the schools in the numbers they are, “is because of the parcel tax.”

“We have great need to retain our current level of crisis counseling,” Mari said.

— Reach Anne Ternus-Bellamy at or 530-747-8051. Follow her on Twitter at @ATernusBellamy

Anne Ternus-Bellamy


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