Youth Suicide Prevention During COVID-19

What does the latest data tell us about the state of child and adolescent mental health? Is suicide a growing concern?

Scott Poland: History would tell us we’d have to expect an increase. Suicide rates have increased after stock market crashes, after the Spanish Flu, after things like SARS in the eastern part of the world. We hear news stories from around the world, stories about whether it was physicians in New York who couldn’t face it anymore or the farmer in India.

So, what does that mean for students? Students lost loved ones. I’ve been encouraging schools to get in touch with kids and families. Find out: how is the quarantine? How did that go? Has your family been affected by the virus in terms of illness or death? Have they been affected financially? I think we have to acknowledge some kids are going to be living in poverty for the first time ever.

You’ve got issues related to suicide — more child abuse. More domestic violence. Alcohol consumption is up. Gun ownership is up. I don’t think anybody has the answers. So, I think this is the time when Americans need more information that suicide is preventable.

Rich Lieberman: I was reading an article about a CDC-reported increase in opioid deaths at this time already. There are lots of substance use surveys where people are reporting increased use of substances during isolation. So, all of those points are risk factors. There is no one cause of suicide; risk factors come together in a perfect storm. We see the components of the perfect storm gathering…so you see more kids exposed to loss, exposed to suicide with increasing suicide rates. And there are some alarming statistics in the latest YRBSS [Youth Risk Behavior Surveillance System], particularly nationally for depression.

When we look at the data captured just before COVID, depression was off the scale for kids. All the statistics were more pronounced for youth and indicated more pronounced general anxiety from day to day. And when you combine that with issues of isolation and limited opportunities for connectedness — like for kids on the other side of the digital divide who don’t have a device — it becomes more complicated.

What advice do you have for school staff and administrators around youth suicide prevention in the current moment?

Scott: Right now schools are not asking much about suicide prevention because they’re not focused on it. They’re focused on mental health and the anxiety and fear for staff. About a month ago I came up with the student COVID-19 safety plan because schools’ ability to open and stay open will depend on students following basic safety guidelines. We’ve already seen that college students aren’t doing it, so it’s crazy to think a middle schooler is going to do a better job of being responsible than college students.

I did a presentation last week for the International School Counselor Association. Among 150 counselors from all around the world, they said most of their administrators have not involved school counselors. So that means they’re not going to involve school psychologists at all because there are far more school counselors. They’re not focusing on suicide prevention and school psychologists, I think understandably, are very concerned the referral for testing is going to go through the roof because kids are going to come back.

So, unfortunately, I don’t think schools are going to be geared up for suicide prevention at all. It’s going to happen and when it happens virtually, for the most part, schools don’t really know.  They should be having Zoom meetings for classmates, helping them with grief. It’s going to take unfortunately multiple deaths, then all of a sudden schools are going to get it. We need to improve our suicide prevention efforts.

Rich: I totally agree that suicide prevention is probably a very low priority. My recommendation to this is: now is the time to establish a suicide prevention task force. This way a district can turn this over to the mental health professionals that have the expertise in order to deal with it.

If we thought students fell through the cracks before, now the cracks are canyons. For school psychologists, right now the primary need is how do we do a virtual suicide risk assessment?  So this task force would consist of administrators and all the school mental health personnel that have to figure out how to do these evaluations. They should immediately review policies and procedures. They should build collaborations with law enforcement and local mental health resources for wellness checks and emergency consultations. Scott and I know for sure probably 80% of American schools don’t have comprehensive policies. They may have an intervention component, but they don’t have the prevention and the postvention component.

The prevention component around suicide prevention right now focuses on building resilience in kids and renewing connectedness. That involves dealing with re-entry and working with PBIS. Now more than ever before, a lot of administrators are going to be more concerned about academics and getting kids graduating on time.

You are both experts in helping schools deal with grief and loss in their communities. For them, how is preparing for this school year different than before?

Scott: I think that they should review whatever they already have written down about dealing with loss. And then they need to look at applying it virtually. In my college, a very popular staff member died suddenly. I basically conducted a Zoom memorial and over 300 people tuned in. About 10% of them actually spoke about the loss. Meanwhile, the chat was unbelievable. Basically every person put something in that chat and that was all recorded for her husband and son.

Even if they didn’t speak, everybody was there because they cared about this person. So, this is what I think a school counselor or school psychologist should do when they’re aware that a teacher or student has died. And just the more that they’re aware that we can do something like this helps, because unfortunately, schools are going to need to do things like that.

Rich: I think that crystallizes both the challenges and opportunities. The challenge is that you’re not going to be able to hug friends and family. But virtually it allows us to come together in a big group and replace the hug in a way that is still intimate.

Otherwise, I would say we’re going to see this for a while. For a third-grader, they have to stand in a certain place and have their temperature taken. They can’t walk six feet close to the other third-graders if they are back in school. At home, there are parents who are saying they can’t take this anymore.  mean those that are going back to school. Those whose parents said, “I can’t take this anymore,” and they want their kids to have more socialization. The impact is going to be devastating.

What would you recommend to a district that wants to get started on building youth suicide prevention resources, but maybe doesn’t have the resources currently?

Scott: One idea about resources is they really need more staff. I would be asking if there is a retired counselor who will come back part-time at modest pay. Or would the local mental health center put somebody in the building on Wednesdays? Could we be using parents or more mentors?

Of course, schools don’t want to be letting more people into school buildings right now, but so many school mental health professionals are overwhelmed. The ratio in Florida is one school psychologist for 2,000 students. That is nowhere close to the recommended ratio.

I believe school counselors and school psychologists at least know where to go to look for a model policy. But, they don’t have any clout. They can’t make it happen. I hate to say it this way, but most youth suicide prevention in schools is the result of staggering tragedies. But convincing them ahead of time I find almost impossible.

Rich: Certainly, we’ve seen a wide range of administrative responses. We’ve seen communities immediately abate suicide clusters based on the magnitude of interventions and changes that they made. And in a lot of these places, districts have created a position like a prevention specialist. We hope they’re still there some years later. But we always try to have new ones talk to old ones and connect them that even though they’re in different parts of the country.

In terms of resources, the school mental health personnel know where to reach out. Now they have easily accessible COVID resources. I helped to develop a couple of checklists for preparing for and conducting a virtual suicide risk assessment for the National Association of School Psychologists.

There is also a simple program that I like from PBIS called Check-in, Check-out, that can be applied virtually. Once a student is identified, they are assigned to a trusted adult at school for check-in, check-out. When we’re in brick and mortar settings, they check-in at the beginning of the day, and they check-in before they go home. It’s rewarded a number of ways, but it also just fosters connectedness. It keeps monitoring kids so that they don’t fall through because, for these kids, survival is day-to-day.

About Scott: Dr. Scott Poland is a Professor at the College of Psychology and is Co-Director of the Suicide and Violence Prevention Office at Nova Southeastern University, Fort Lauderdale, Florida. Dr. Poland is a licensed psychologist and internationally recognized as an expert on youth suicide, self-injury, school violence, school safety, threat assessment and school crisis. He has authored or co-authored five books and many chapters and articles on these subjects including, Suicide in Schools, published in 2015. He co-authored the Suicide Safer Schools Plan for the state of Texas and previously directed psychological services for a large Texas school system for 24 years. Dr. Poland is a past President of the National Association of School Psychologists, and past Prevention Division Director of the American Association of Suicidology. He has been an expert witness in numerous legal cases surrounding suicide tragedies in school communities. Dr. Poland is dedicated to prevention and has testified about the mental health needs of children before the U.S. Congress on four occasions. He is a founding member of the National Emergency Assistance Team and has personally assisted school communities following school shootings, acts of terrorism, natural disasters and numerous suicide clusters. Dr. Poland is known for his dynamic and practical presentations that include many real life experiences on the front line of crisis prevention, intervention, and postvention.

About Rich: Richard Lieberman MA, NCSP is a Lecturer in the Graduate School of Education at Loyola Marymount University and from 1986-2011 he coordinated Suicide Prevention Services for Los Angeles Unified School District, the second-largest school district in the US. He has co-authored numerous book chapters on suicide intervention in the schools; consulted nationally with districts experiencing suicide clusters; served on the Steering Committee for the Suicide Prevention Resource Center and contributed to both the SAMHSA Preventing Suicide and SPRC/AFSP After a Suicide school toolkits.

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