While it is outside the scope of this toolkit to fully explore the phenomenon of imitative suicidal behavior (see Additional Information), what follows are general guidelines for school communities facing possible contagion.
Contagion is the process by which one suicide death may contribute to another. In fact, suicide(s) can even follow the death of a student from other causes, such as an accident. Although contagion is comparatively rare (accounting for between 1 percent and 5 percent of all suicide deaths annually), adolescents and teenagers appear to be more susceptible to imitative suicide than adults, largely because they may identify more readily with the behavior and qualities of their peers.
If there appears to be contagion, schools should consider taking additional steps beyond the basic crisis response outlined in this toolkit, including identifying other students who may be at heightened risk of suicide and actively collaborating with community partners in a coordinated suicide prevention effort.
Identifying Other Students at Possible Risk for Suicide
In the face of apparent contagion, it is important for schools to utilize counselors and others who have been trained to identify students who may be at heightened risk for suicide due
to underlying mental disorders or behavioral problems (such as depression, anxiety, conduct disorder, and/or substance abuse) and who have been exposed to the prior suicide either directly (by virtue of close identification or relationship with the deceased) or indirectly (by virtue of extensive media coverage).
Of special concern are those students who:
- have a history of suicide attempts
- are dealing with stressful life events such as a death or divorce in the family
- were eyewitnesses to the death
- are family members or close friends of the deceased (including siblings at other schools as wellas teammates, classmates, and acquaintances of the deceased)
- received a phone call, text, or other communication from the deceased foretelling the suicide
- may have fought with or bullied the deceasedSchools can also seek to identify those in the general student body who may be at heightened risk by using a mental health screening tool (a process sometimes called case finding) such as TeenScreen Schools and Communities of the National Center for Mental Health Checkups (http://www.teenscreen.org), Signs of Suicide (http://www.mentalhealthscreening.org), or others listed in the Suicide Prevention Resource Center/American Foundation for Suicide Prevention Best Practices Registry (http://www.sprc.org).
Connecting with Local Mental Health Resources
Schools should work with local primary care and mental health resources (including pediatricians, community mental health centers, and local private practice mental health clinicians) to develop plans to refer at-risk youth. Once plans are established, they should be reviewed with school counselors and other personnel so that any student who is identified as being at high risk can be referred to a local mental health screening center or private practitioner for further evaluation.
Managing Heightened Emotional Reactions at School
The possibility of a suicide cluster can be exceedingly upsetting. At a minimum, school counselors and/or trained outside professionals should be available to meet with distraught students for grief counseling and to help them make linkages with other resources in the community.
Schools, in partnership with community mental health resources, might also consider creating drop-in centers that provide a safe place for youth to be together after school hours. These
can be staffed by volunteer counselors and clinicians from the community who can provide grief counseling as well as identify and refer youth who may need additional mental health or substance abuse services. These centers can also be used during times of particularly heightened emotion such as graduation or the anniversary of the death(s).
Monitoring Media Coverage
Particularly when there have been multiple suicides, media interest in the deaths will be intense. The school should delegate one spokesman for public statements, disseminate the document Reporting on Suicide: Recommendations for the Media, and follow the safe messaging guidelines at http://www.sprc.org/library/SafeMessagingfinal.pdf. The risk of contagion is related to the amount, duration, and prominence—as well as the content—of media coverage, so it is extremely important that schools strongly encourage the media to adhere to the parameters set forth by the nation’s leading suicide prevention organizations. These recommendations include:
- not glamorizing or romanticizing the victim or suicide itself
- not oversimplifying the causes of suicide
- not detailing the method
- not including photographs of the death scene or of devastated mourners, which can beattractive for vulnerable youth who may be desperate for attention and recognition
- including hotline numbers (such as Lifeline: 800-273-8255) and information about localmental health resources in each article
Building a Community Coalition
Schools cannot possibly manage all aspects of reacting to possible contagion and preventing its spread without collaborating with community partners. It is strongly recommended that the community convene a coordinating committee that can meet on a regular basis and serve as a decision- making body and identify a leader for these efforts. The committee should include senior representation from the school, together with representatives from as many of the following
• law enforcement
• government, such as the mayor’s office, medical examiner’s office, and public health department • parents who have demonstrated community leadership in addressing drug and alcohol abuse,
bullying, or other related issues
• mental health community, such as community mental health centers, psychiatric screening
centers, private practitioners, and substance abuse treatment centers • social service agencies
• funeral directors
• first responders and hospital emergency room personnel
• media (as coalition members, not to cover it as a news event)
• suicide bereavement support group facilitators
• primary health care providers/clinics
The committee’s initial goals should include:
- Identifying a leader or lead agency
- Identifying any particular risk factors within the community, such as widespread drug andalcohol use, bullying, or easy access to means of suicide
- Mobilizing existing mental health and primary care resources to identify and help youngpeople who may be at high risk
- Mobilizing law enforcement to patrol locations where youth may gather to memorialize thedeceased and/or engage in risky behaviors such as drinking or drug use
- Mobilizing parents to assist in monitoring youth who come to their homes and neighborhoods
- Reaching out to other groups and businesses in the community where youths gather, such asrecreation centers, religious organizations, sports leagues, movie theaters, and diners
The committee should also consider the gaps in existing resources and identify additional resources that may be needed, such as:
- Creating a position for a suicide prevention resource coordinator
- Hiring or contracting for additional counseling staff in affected schools
- Hiring staff to provide screening programs in affected schools, such as Columbia Teen Screen
- Developing alcohol and drug programs for youth
- Developing teen centers where youth can come together and engage in social and recreationalactivities with caring adults
- Creating a public awareness campaign or website to educate the community about mentaldisorders, substance abuse, and other at-risk behaviors, and to decrease stigma and increase help-seeking. Examples of safe messaging can be found at http://www.sprc.org/library/SafeMessagingfinal.pdf
- Creating public service campaigns to educate the community about suicide risk factors, warning signs, and local resources for those at risk
- Identifying ways to reach at-risk youth who are not in the education system, such as recent graduates, dropouts, or those in the juvenile justice system
- Identifying and implementing ways to reduce access to means
- Exploring eligibility for additional sources of funding, such as a U.S. Department of Education School Emergency Response to Violence (SERV) grant, awarded to school districts that have
experienced a traumatic event and need additional resources to respond.