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“Treating and
Preventing Suicidal
Behavior”
Presented by
Peggy G. Kubert, MA, LCSW
Executive Director of Erika’s Lighthouse:
A Beacon of Hope for Adolescent Depression
October 1, 2012
Our Guiding Messages
You are not alone.
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Depression is common.
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It is a serious illness.
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It’s treatable.
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There is always help and hope.
“You deserve to feel better.”
Why is Teen Depression Important?
• As many as 20% of teens will have at least one
depressive episode before adulthood
• Two-thirds will go undiagnosed and untreated
either out of failure to recognize the symptoms
or because of shame
• Untreated depression is responsible for more
suicide deaths than any other single risk factor
• 90% of teens who die by suicide have some
form of mental illness.
SAMSA, 2009
NAMI, 2003
Institute of Medicine, 2002
Top Ten Causes of Death in Youth Ages 11 – 24
(Center for Disease Control, 2004)
16,760
5,272
4,587
2,118
1,180
641
248
238
229
207
Unintentional Injury
Homicide
Suicide
Cancer
Heart Disease
Congenital Anomalies
Cerebrovascular
Chronic Respiratory Disease
Influenza & Pneumonia
HIV
Illness Related Cause of Death in Youth
Ages 11 – 24
(Center for Disease Control, 2004)
4,587
2,118
1,180
641
248
238
229
Suicide
Cancer
Heart Disease
Congenital Anomalies
Cerebrovascular
Chronic Respiratory Disease
207
Influenza & Pneumonia
HIV
Suicide Warning Signs
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Observable signs of outward depression
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Increased risk taking behavior
Increase in alcohol & drug use
Impulsiveness
Risky sexual behavior
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Threatening suicide or expressing wishes to die
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Definitive plan
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Increased rage and anger
Risk Factors:
Static & Social/Environmental
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Family history of suicide or suicide attempts
Parental mental health problems
LGBTQ and questioning teens
History of physical or sexual abuse
Previous suicide attempt
Access to firearms or other lethal means
Impaired parent-child relationship
Difficulties in school, falling grades, not attending school, bullying
Social isolation – feeling like you don’t belong anywhere
Stressful life events (legal, break-ups, family problems, death of a loved
one)
Recent suicides/attempts in school or social group
Harris, Br J Psychiarty.1997; Shain. Pediatrics. 2007;120:669-676
Risk Factors:
Psychiatric
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Most common psychiatric risk factor resulting in suicide:
– Depression*
• Major Depression
• Bipolar Depression
• Alcohol & Drug Abuse
• Schizophrenia
Other psychiatric risk factors
– Post Traumatic Stress Disorder (PTSD)
– Eating disorders
– Non-Suicidal Self-Injury
Harris, Br J Psychiarty.1997; Shain. Pediatrics. 2007;120:669-676
What is depression?
A disorder of the brain that affects
our thoughts, moods and behaviors
Must have at least FIVE symptoms for most of every day
for two weeks or more
• Sad, depressed or irritable mood
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Little or no interest in pleasurable or favorite activities
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Significant weight loss, weight gain or change in appetite
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Insomnia or hypersomnia
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Psychomotor agitation or retardation
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Fatigue
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Feelings of worthlessness; excessive or inappropriate guilt
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Diminished ability to think or concentrate; indecisiveness
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Recurrent thoughts of death, suicidal ideation, suicide
attempt or plan
Signs in School
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Sad, depressed or irritable
mood
Loss of interest in favorite
activities
Significant weight loss or gain
Restlessness, agitation or
anxiety
Fatigue or loss of energy,
including sleeping in class
Feelings of guilt
Low self-esteem
Trouble concentrating or
making decisions
Repeated thoughts of death or
suicide, expressed verbally or in
writing
•Frequent headaches and stomach-aches
•Cutting or other self-injury
•Extreme aggressiveness
•Inattention to appearance
•Excessive risk-taking behavior
•Drop in school performance
•Low tolerance for frustration
•Lack of motivation, apathy
•Disrespect
•Social withdrawal
•Misbehavior
•Unable to store or retrieve information
•Forgotten materials/assignments
•Frequent absences, trips to school nurse
•Crying in class
When talking with students…
Never promise to keep a secret discuss limits of confidentiality.
Ask general questions:
“how have you been doing?”
“what kind of things have been
stressing you out lately?”
“How have things been going with
(school, friends, parents, sports?)”
Follow-up with more detailed
questions.
Questions for students…
If concerned about depression:
“Everyone feels sad, angry, stressed or irritable at
times. How about you?”
If concerned about suicide:
“Have you ever thought about killing yourself or
wished you were dead?”
“Have you ever done anything on purpose to hurt
or kill yourself”
Remember, this is an illness
—no blame, no shame
Jason J. Washburn, Ph.D., ABPP-CC, Director,
Center for Evidence-Based Practice
If he said “NO” – now what?
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Be honest and compassionate.
“You deserve to feel better and we will help you
at any time.”
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Encourage discussion.
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Keep the door open for future conversations.
If she said YES – now what?
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Remain calm and acknowledge the deep despair –
“sounds like things have been really difficult.”
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Provide reassurance that you have heard them and
you will help.
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Keep the student with you at all times- Do not wait,
act immediately, and follow your school protocol. If
need be, call security.
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Notify parents or guardian immediately and arrange
crisis care which may include going to the hospital
for a psychological evaluation.
Involving Parents
Encourage parents to talk to the child’s pediatrician to
rule out another illness.
Get a mental health assessment for an accurate
diagnosis.
Offer recommendations for a therapist that fits
the child’s needs and personality. May need
talk therapy, medication management, or both.
Facilitate communication between parents and
other adults, therapists and the school.
Educate and assist parents to manage their fears and
anxiety.
What Can Schools Do?
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Have a protocol to establish a culture of mental
health in the school and to get students the help
they need if they are suffering from depression or
another mental illness
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Establish a mental health task force and determine
what is currently in place to address mental illness
and mental health
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Train faculty to recognize signs of depression and
suicide & make appropriate referrals
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Develop a protocol to address the concerns of the
faculty or staff about a student
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Develop a protocol for taking immediate action if a
student is in danger of taking her or her life, self –
injury or injury to others
What more can schools do?
• Teach mental health curriculum and promote
social and emotional well being
• Set up supportive environment that models
good mental health - evaluate stress factor in
school
• Build in accommodations and flexibility
• Provide a safe haven for respite
• Encourage continuous communication and
collaboration
• Establish a “student voice” which will encourage
students to be respectful and aware of stigma
around mental illness
Erika’s Lighthouse Programs and Materials
For Schools:
•The Red Flags Program,
depression education for 5th8th grades
•Real Teenagers Talking
About Adolescent Depression:
A Video-Based Study Guide
For Teens:
•Helping high school students
start and run an Erika’s
Lighthouse Club at their school
•Training teens to present
educational Teen Panels and
share stories about depression
to younger students and peers
For Parents:
•A video and Parent Handbook on
Childhood and Adolescent
Depression, how to get help and
what parents need to know about
depression and treatment
For Everyone:
•An annual Walkathon to raise
awareness and to “get depression
out of the dark”
•School, parent and professional
workshops on depression awareness
and suicide prevention
•Our website: erikaslighthouse.org
Red Flags/Claire’s Story
for Middle School
•Video based curriculum
•Diagnosis and symptoms of
depression
•Treatment plans
•Living with depression
www.redflags.org
We provide the training and materials for this
curriculum to teachers, support staff, and
parents at no cost to schools
Our study guide
Based on our video, Real Teenagers Talking
about Adolescent Depression
Brief exercises to deepen teens’ understanding
of depression
Exercises on the science of the brain and
depression, the stigma surrounding depression
and bullying and depression
Order at
erikaslighthouse.org
Exercises on coping with stress and building
resiliency and how to help a friend who is
suffering from depression
Suggested Mental Health Protocols for Schools
Online Resources for Mental Health, Stigma,
Coping & Bullying
Takeaway
Bookmark includes:
• the signs and symptoms of
depression
• tips on how to help yourself
• tips on how to help a friend
• space to write the name of a
trusted friend you can talk to
What A Difference A Friend Makes
• Be understanding and supportive.
• Let them know they’re not alone.
• Know there’s a limit to what you can do. Encourage talking to an
adult who can help.
• Have patience. Don’t expect them to just “snap out of it”.
• Don’t enable isolation, even when being pushed away. Being
present can make a huge impact.
• Stay positive.
• Emphasize the fact that depression is a treatable condition and to
go get help.
Suggestions for self care:
You can’t be available to your students
if you don’t take care of yourself.
1.
Maintain a healthy lifestyle
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Practice stress management
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Set Boundaries
4.
Have Fun
Good Mental Health: our ultimate
goal.
What does good mental health look like?
1. Strong meaningful relationships
2.
A purpose to one’s life
3. Setting and achieving goals
towards that purpose
Get Depression Out of the Dark
www.erikaslighthouse.org