Recognize, Respond, Refer

Recognize – Warning signs

Awareness of the factors associated with increased risk for suicide can potentially help in identifying vulnerable students. As staff and faculty, it is important to become familiar with warning signs that could indicate a student is in distress. Look for signs of distress in a student’s behaviour, their emotions, what they are communicating, and how they are communicating.

Common signs of distress¹http://www.togethertolive.ca/risk-management:

• engaging in reckless or risky behavior
• increased use of drugs or alcohol
• talking, writing, or posting on social media about death, dying or suicide
• threatening to hurt or kill themselves
• expressing feelings of worthlessness, hopelessness, life is not worth living, or feeling like a burden to others
• withdrawing from friends, activities, school
• changes in mood, including anger and agitation
• not taking care of their appearance (e.g. not washing, looking disheveled, clothes not clean)
• giving away possessions
• saying goodbye to loved ones

Respond –Signs of distress

It is always important to take any of these warning signs seriously. Act immediately, find a private spot to let the student know that you are concerned and explain why. Take some time to build rapport with the student, to describe specifically what you have noticed, and to ask them directly about suicide. Make sure you remain calm and stay in control.

Here are some ways you might get the conversation started:

“I am really concerned about you”. (Describe what you have noticed.) “Can we talk about this?” (Listen.) “Sounds like you have a lot going on and are feeling overwhelmed. Sometimes when we are feeling overwhelmed we start to struggle with how to move forward. This can often lead us to start thinking suicide is an option. Have you been thinking of suicide? Of ending your life?”

The following resource, found on the online youth suicide prevention toolkit togethertolive.ca, offers some additional tips for talking about suicide: http://www.togethertolive.ca/sites/default/files/ttl_how_to_talk_about_suicide.pdf

Many people worry that asking directly about thoughts of suicide may cause people to consider death by suicide. Research is clear that asking someone if they are having thoughts of suicide does not increase risk. Conversely, it demonstrates to the individual that you are serious about helping them and creates an opportunity to discuss possible thoughts of suicide and the things in their life they may be struggling with. Getting that conversation started is one of the greatest gifts you can offer to a person thinking about suicide.²Preventing suicide: a global imperative is a 2014 report by the World Health Organization

Although your role as staff or faculty often provides opportunities for you to become aware of risk and get the conversation about suicide started; your role in management of the risk of suicide is in providing a bridge to appropriate resources.³http://www.togethertolive.ca/best-practices-risk-management

As a staff or faculty member you are not expected to deal with a student in distress alone. If you are unsure or uncomfortable with how to start this conversation with a student, there is help . Reach out to mental health providers on campus and let them know of your concerns. They can help.

If a student answers “yes” to having thoughts of suicide, stay calm and actively listen for an understanding of how the student is feeling. Remember that this is not the time for judgement or advice. Just listening.

Here are some questions that you might want to consider asking….

“I am sorry that things have been so difficult for you. It sounds like you are in a tremendous amount of pain. Can you help me to understand why you are thinking about suicide at this particular moment in time?”

“How often do you find yourself thinking of suicide? Is there a particular time of the day or in certain situations where these thoughts are more present?”

“Have you thought about how you might want to end your life? Where or when?”

Use active listening techniques such as eye contact, nodding and clarifying what you heard to reassure the student they are truly being heard. Remember: an authentic personal connection can be a protective factor for suicide.

“So, what I am hearing is that these thoughts started when your relationship ended”.

“Night time seems like a really difficult time for you and not sleeping is really affecting your ability to focus on your schoolwork, and this  is creating even more pressure for you”

Refer – campus or community mental health services

As staff or faculty, you are not expected to assess risk for suicide. Your role is to listen, be supportive and connect the student with someone who can assess their risk for suicide and help them stay safe. Staying safe will look different for each student, but it will include things like assessing for potential mental health concerns, supporting the student with the issues in their lives that are overwhelming them, identifying a network of support and creating a personal safety plan. As staff or faculty, you should be familiar with mental health and crisis supports on campus including having hours and contact information readily at hand.  Resources available on your campus are found on this site under Referrals.  You should also check to see if your campus has a suicide prevention policy that could offer additional direction and resources.

Emergency Referral

If you believe that a student has a clear and active intent to die, has a plan or the means available, is overly agitated, emotional, uncooperative, or has already made a suicide attempt the situation is urgent. Immediately call a crisis team, call 911 or bring the student to the emergency department yourself. Most importantly, do not leave the student alone. Most campuses will have very clear policies around this. Please take a moment to familiarize yourself with them.

Non-Emergency Referral

Although you might very well experience a student that requires immediate emergency services it is more common that students thinking of suicide will be feeling ambivalent about suicide, will not have considered a plan or means and will realize they need some help. In this instance you should support the student to pursue further assessment, either on campus or through another mental health service. Take some time to discuss the options for referral with the student. Remember: if you are feeling unsure about what referral to offer, reach out to campus crisis/mental health services for support. They can help! You are not alone!  A list of services available on your campus is found in the Referral section of this website.

A Note About Consent

Consent to disclose information about a student should always be taken seriously and whenever possible it is best to obtain direct consent. However, if you believe that a student is in danger of hurting themselves or others then sharing this information with mental health resources or police is appropriate.

In the respond stage, it is important to listen. In the refer stage, actively support the student to make a connection to a mental health professional for further assessment and support. Reassure the student that while suicide is serious, there are many people on campus that can help.

You might say something like….

“Having thoughts of suicide is serious. I think we need to connect with someone that can help you to stay safe from acting on thoughts of suicide when things get difficult for you. They can also help you get some support to work through the things in your life that are overwhelming. How does that sound?”

At this point in the conversation, you may get resistance from a student at risk. They may try to reassure you that they are going to be okay. They may also tell you that they would never actually act on their thoughts. Regardless, as a faculty or staff member, your role is to connect this student to professionals that can assess the level of risk and ensure the student gets the support they need.

 “I know you are sharing that right now you feel ok, that you would not do anything to harm yourself. However, having thoughts of suicide does put your life at risk and that risk can shift often and unexpectedly. I want you to be prepared if that should happen in the future. A support person on campus can help you with that and help you to be prepared with a plan to stay safe.”

If the student continues to resist seeking help, then you need to be direct about your concern and desire to get others involved to offer additional support.  Again, you may want to familiarize yourself with your campus policies and procedures on suicide. If your campus does not have such a policy, follow up with the Wellness/Counselling Centre as they will be able to provide you with some direction.

Here are some things to keep in mind during this time:

• Decide together what on campus resources will work best for the student. Go with them or call directly to ensure they make a connection.
• Ask if there is another supportive person they would like to have with them during this time.
• Explain each step to the student, who you might connect with, and what you are going to share. The goal is to have no surprises for the student.
• Discuss with the student what specific information you will be sharing and with whom.

The conversation might sound like….

“So, we have a few options for connecting you to campus services. I could call the crisis team or we could walk over to campus health together? Is there anyone else you might like me to call right now? Your parents? Your partner? Just to let you know I must call my supervisor to let them know I am supporting a student in distress. I will not share any details of what we talked about, just your name and that you are in distress and that I am taking you to get some support. OK?”

Now that the referral process is complete here are a few other things to keep in mind:

• you might want to let the student know if and when you can be available to listen in the future if that is appropriate.
• Supporting someone with thoughts of suicide is stressful and it is normal to feel a range of feelings in the aftermath. Remember: offering this type of support is about helping someone to keep themselves alive. It is not about you being responsible for their life.
• Take some time to look after yourself in the days that follow. Consider the self-care approaches that work for you.
• You may also wish to talk to a mental health professional about the experience so you can process it appropriately.