Saturday, August 16, 2014

Teen Male Suicide Awareness: A Toolkit for School Counselors

Saturday, August 16, 2014

The first time I met Casey (not his real name) was in 9th grade when he was referred to his school counselor by one of his good friends for making statements about hurting himself.  Casey's counselor was not at school that day; therefore, he was brought to me.  When he walked in my office, it was like a heavy cloud descended into my room.  Physically, the student was a mess...he was hunched over, his brow was furrowed with heavy creases, and he had a blank look on his face.  After delivering my normal informed consent, he immediately let me know that he hated his life and had often thought how much happier everyone would be without him.  Clearly, this student was depressed and had suicidal ideations. 

After giving Casey a suicidal risk assessment, his parents were contacted and asked to pick him up from school to take him for an evaluation.  When the parents arrived, they admitted that they were not shocked by his behavior and were use to his threats.  Apparently, Casey had been depressed since he was young boy and had been seeing a physician on and off for his moodiness.  The parents told me that they felt he would eventually outgrow his malaise so they decided to take him out of counseling.  At that point, the social worker and I both insisted that the student continue mental health services and we would check up on him in a few days. 

Now, fast forward to his junior year. That year, I noticed that Casey came to see his school counselor regularly about his emotional outbursts in class.  Unfortunately, the sad little freshman had now become a very ill tempered young man.  His jaw was always clenched, he never smiled, and if you asked him how he was doing he would often give a negative response (sigh).   Alas, there was a glimmer of hope for Casey. During his junior year, he started dating one of the sweetest and most positive young ladies that I knew at the time.  In fact, the two dated for almost a year until she was worn down by his chronic bad moods and unhappiness.  One day, after having taken all she could bear, she decided to break up with him.  In his quest to win her back, he made many promises that he would be a better man and he would treat her like she deserved.  However, the relationship failed a second time and she broke up with him again. 

Unable to cope with this final rejection, Casey called her on the phone.  While the two were arguing on the phone, he decided to kill himself.  The news of Casey's death spread like wildfire through school and many of Casey's friends were devastated.  However, the saddest part of the story was that everyone predicted that Casey was a young man on the verge of suicide. In fact, many students and staff members said he was a ticking time bomb ready to explode. Truly, this was one of the saddest events that I had ever experienced at a school. 

The story of Casey is not that uncommon in our society.  Everyday, there are thousands of young men who are just one moment away from ending their lives due to depression.  Often we think of teen suicide as a female issue, but the reality is that males successfully complete suicide more often than girls. If you take a look at the list of males who have died from suicide in the news, many of them were very talented, smart, and popular men.

Robin Williams-I grew up watching Robin Williams on Mork and Mindy. His wit and charm made him one of the greatest comedians of his time; however, he hid a dark secret that only close family and friends knew about...he suffered from bouts depression and was recently diagnosed with Parkinson's.








Phillip Seymour Hoffman-The first time I saw Hoffman was in the movie Twister.  Following his early career, in less than stellar films, his career exploded with him getting very poignant roles like Truman Capote.  Hoffman suffered from bouts of drug addiction and one evening ended his life with prescriptions and heroin.






Kurt Cobain-Okay, I admit it, I did not start listening to Nirvana until I learned about his completion of suicide.  In his death, Kurt Cobain became more popular than he ever was when he was alive. His death has made him a famous rock and roll hero for many teens.




Lee Thompson Young-I remember him as the Famous Jett Jackson who grew up to star on a prime time cop show until his death in 2013. Young suffered from bi-polar and took his life during the peak of his career.



Jevon Belcher- Jevon was a professional athlete who was much loved by his teammates.  Belcher was a former player for the Kansas City Chiefs who killed his girlfriend and himself publicly at the team headquarters.





Chris Benoit-Benoit was a famous WWE wrestler who suffered from a brain injury which made have led to mental illness.  In 2007, Benoit killed his wife and son and then committed suicide.





Don Cornelius-Cornelius hosted the popular hit show Soul Train.  As his health declined, Cornelius became depressed and decided to take his own life.




Reality of Male Suicide

From an early age, our society has made it clear to our boys that we do not tolerate weakness.  Little boys are discouraged from crying ("don't let me see your cry" or "cry baby") and to not show emotions ("act like a man" or "be tough").  Unfortunately, many males do not possess the resiliency to deal with life's problems or lack the ability to talk about their emotions with their friends or family. Therefore, discouraged from seeking help, many males turn to risky behaviors, drugs, alcohol, or isolation to cover up their issues (Men and Suicide, by Robert Olson).  This week, one of rock and rolls most famous "jewels", affirmed society's expectations about people experiencing depression. Gene Simmons (bassist for KISS), who is not known for his empathetic nature, was interviewed by Songsfact.com. In his interview, Simmons stated that he did not get along with others who used drugs and alcohol or threatened suicide. At one point in his interview, he said, "Why are you announcing it? Shut the @#*$ up, have some dignity and jump! You've got the crowd." Gene Simmons Interview
After the interview, there was a huge backlash from fans, radio stations refused to play KISS songs, and he even got a tongue lashing from another rock and roll legend, Nikki Sixx.  Sixx (bassist from Motley Crue) felt that Simmons' words could cause a fan to resort to suicide since his idol said "it is a solution".  Sixx, who struggled with depression and addiction, said that he wants teens to know that there is a way out of their depression and they need to know how to get help. 

Nikki Sixx v Gene Simmons

The stats support the problem of suicide among males. According to the Centers for Disease Control, in 2009 1,852 young people from the ages of 13-19 committed suicide.  Of those teens, 78 percent were males and 22 percent were females. Males are less likely to open up about their stress or depression.  Instead of opening up, males tend to express themselves through risky behaviors (Centre for Suicide Prevention, 2011). Since males are less likely to talk about their issues and stressors, school counselors should be aware of the warning signs and risk factors for suicide.

Facts about teen suicide:
  • Suicide is the third leading cause of death in teens ages 13-18 and the second leading cause of death in college aged students.
  • 1/4 of all teens who committed suicide were reported to have drugs or alcohol in their system.
  • Nearly all youth who commit suicide had a diagnosable mental health disorder at the time of their death.
  • There are 25 attempted suicides for every one completed suicide.
  • One out of five high school teens have thought about suicide in the past year.
  • Suicidal behaviors and non-suicidal behaviors are the largest reason for emergency room visits.
  • Although handguns account for the largest method of suicide for all genders and ages, more and more teens are now resorting to hanging and pills.

Warning Signs in males:
  • Depression often masked as irritability, anger, or hostility.
  • Risk taking behaviors
  • Avoidance behaviors
Risk Factors for males:
  • Alcohol and drug abuse
  • Social isolation
  • Lethal means to complete suicide
  • Reluctance to seek help
If you realize that you have a male student exhibiting these signs, it is important to identify his protective factors. Protective factors include: social supports, peers, stable home environment, and treatment.

Suicide Contagion

Although Robin Williams was a talented comedian and actor, there are dangers to overexposing his suicide in the media. In a study of teens ages 12-17, researchers found that one person's suicide can influence another person's suicide or thoughts. Dr. Ian Colman found that when the deceased is spoken about in glowing terms and idolized, a vulnerable youth may want others to feel and talk about him or her in the same way.

In Dr. Colman's research of 22,000 teens, he found that teens ages 12-13 were five times more likely to contemplate suicide while teens ages 15-17 were three times more likely to think about committing suicide. From his study, Dr. Colman found that suicidal contagion does exists and he believes that school-based interventions work more effectively than high-risk interventions aimed solely at helping the friends of the deceased.


Like the media, activities at school can contribute to contagion; therefore, it is important that schools create consistent policies regarding the glamorization of a celebrity or student's death.  One example of glamorization that was created and shared was from the Academy of Motion Picture Arts and Sciences. The tweet featured a picture of Robin Williams as the Genie being embraced by his former master Aladdin.  Under the picture was the caption, "Genie, you're free." The American Foundation for Suicide Prevention says that suicide should never be presented as an option because it can create a formula for suicide contagion.

Controversial Picture by the Academy of Motion Picture Arts and Sciences

In addition to creating guidelines for social media by Suicidologists, the Society for the Prevention of Teen Suicide has created a list of guidelines for schools regarding memorials after a suicide.

Inappropriate memorials for schools include:
  1. Flying the flag at half-staff.
  2. Putting a message about the student's death on the outside school message board or marquee.
  3. Letting students create and wear tee-shirts, clothing, or armbands with the student's picture or information at school.
  4. Planting a tree or garden for that student.
  5. Placing plaques for that student in the school corridors.
  6. Naming rooms or stadiums for that student.
  7. Creating and hanging banners about the student.
  8. Dedicating dances, sporting events, or yearbooks to the student.
  9. Making acknowledgements about that student at graduation.
Appropriate memorials include:
  1. Making donations to crisis centers.
  2. Participating in an event that raises suicide awareness like Suicide Awareness Day.
  3. Buying books in the library that raises awareness about suicide and promotes resiliency.
  4. Creating service based activities that promote students taking care of each other and listening to one another.  One example is to create a peer helping organization at your school trained in peer listening and suicide awareness. National Association of Peer Program Professionals
  5. Implementing a suicide prevention program at your school.
  6. Collaborating with a local suicide coalition or mental health organization.

What can school counselors do to help males in schools?

1.  Create a peer helper group and train them in suicide prevention skills.  Research has shown that peers are more apt to turn to peers during a suicidal crisis than adults.
2.  Go into the classroom and educate students about suicide awareness.  Suicide Awareness Curriculums should include warning signs, risk factors, and resources for students. When selecting a curriculum to use, avoid a one time approach, one that emphasizes suicide as a result of stress, does not include media depictions of suicides, and should include a staff component. 

Here are some suggested curricula to review:
  • Lifelines Curriculum - addresses the whole school by teaching students a consistent model for identifying the signs of suicide and the roles of students in the school community.
  • Gatekeeper Training - online training that will allow students and staff to recognize the signs of suicide and how to refer someone for help.
3.  Seek training in suicide screening instruments. Some examples include the Signs of Suicide Screening Program and the Columbia Suicide Severity Rating Scale.
The CSSR has a free training component that you can take online!
4.  Create a resiliency group for students who are identified as "at-risk".   The group can focus on social support, sense of belonging, leadership, coping skills, and problem solving skill building.
5.  Download the Preventing-Suicide-A Toolkit for High Schools from SAMSHA. This toolkit can assists schools in implementing strategies to present suicides.
6.  Download the After a Suicide Toolkit for Schools which gives guidance to schools on how to handle and prevent a difficult situation from occurring following a student suicide.  Also, this is a great kit to prevent contagion.
7.  Consider sponsoring or participating in an Out of the Darkness Campus Walk to raise awareness for staff, parents, and students about suicide in your community.
8.  Think about joining a local suicide coalition to receive free training and information.  My local chapter sponsors Mental Health First Aid Training, Gatekeeper Training, Lifelines Suicide Awareness, and much more!!
9. Educate yourself and your colleagues!  Here are some free resources:
10. Participate in World Suicide Awareness Day on September 10th in your school.


I hope you will become more informed on youth suicide as it can make a big difference for your students!  Also, I would love to hear strategies and trainings you have implemented in your school community.