It can be hard to find the right words if you’re feeling overwhelmed and emotional yourself.
Suicide prevention starts with recognising the warning signs and taking them seriously, talking to the young person about what’s going on and helping them seek professional support. With support, they can find ways to manage their distress and get through the crisis.
If you become aware of suicide warning signs in a young person, it’s important to notify the school wellbeing team or the principal (depending on the school’s protocol).
It’s not your responsibility as an educator to assess and manage young people who may be at risk.
A risk assessment should only be done by a mental health professional or a staff member with specific training.
What is a risk assessment?
A suicide risk assessment is a direct conversation with a young person about their suicidal thoughts, plans and intent. It’s working out the young person’s risk and using it to inform the level of response needed.
Suicide warning signs
There are several possible warning signs that may indicate a young person is at risk of suicide. These include:
- a sense of hopelessness or no hope for the future
- isolation or feeling alone — “No one understands me”
- aggressiveness and irritability — “Leave me alone”
- possessing lethal means — medication, weapons
- negative view of self — “I’m worthless”
- drastic changes in mood and behaviour
- frequently talking about death — “If I died would you miss me?”
- self-harming behaviours like cutting
- engaging in ‘risky’ behaviours — “I’ll try anything — I’m not afraid to die”
- making funeral arrangements
- giving things away (clothes, expensive gifts) — “When I am gone, I want you to have this”
- substance abuse
- feeling like a burden to others — “You’d be better off without me”
- talking about suicide and death — “Sometimes I feel like I just want to die”.
Other risk factors may include:
- sexual orientation: Young men from LGBTQIA+ communities are more likely to make suicide attempts than heterosexual males
- gender: Females have a higher risk of suicide attempt and males a higher risk of suicide death.
- mental health conditions
- internalising symptoms, such as depressive or anxiety symptoms
- externalising symptoms, such as legal problems, truancy, aggression or behavioural issues
- school absenteeism.
It’s important to note that you can’t always predict suicidal behaviour based on risk factors. Suicide is almost always the result of a complex interaction of many factors.
The first conversation
Sometimes educators can play a role in having a first conversation with the young person about their thoughts about suicide.
There are three key steps in this conversation.
1. Take the time to talk
The first step to supporting people considering suicide is to start a conversation about it. By being calm, non-judgemental and empathic, you provide an opportunity for a young person to discuss their suicidal thoughts.
Talk to the student in a private and confidential manner. Let them know you’re worried about them, and why.
2. Talk about suicidal thoughts
It can feel uncomfortable asking someone directly about suicidal thoughts or plans, but it’s necessary to check whether a person is at risk and how imminent that risk is.
Don’t be afraid to ask direct questions about suicide. Asking a young person about suicidal thoughts won’t put the idea in their head. While everyone has their own personal communication style, it’s important to be direct when asking about suicide.
Asking questions directly can also be a huge relief for a young person struggling with thoughts of suicide. It gives them permission to speak openly about how they’re feeling and the opportunity to gain support.
Asking direct questions can help you to determine if they’re in immediate danger and in need of assistance.
Here are some ways to ask a young person if they’re considering suicide:
- “Are you feeling so bad that you’re thinking about ending your life?”
- “Are you having thoughts about suicide?”
- “Do you ever wish you were dead?”
You should never promise to keep thoughts or feelings about suicide a secret.
Keeping the secret may be extremely harmful, if not fatal. Be sure to tell the young person that you’re unable to keep their secret. Even if they seem upset with you now, it is essential to ensure they remain safe.
3. Link into supports
Take all discussions about suicide seriously.
Let young people know there are supports available and that you’d like to help them to work out the next steps.
Explain your role and ask them to come with you to talk with the relevant staff member about what support is available to them. The staff member trained in suicide risk assessment can then continue the conversation to determine how at risk the young person may be and what actions are required to keep them safe. For example, you might say:
“I can hear how difficult things are for you now, and I think there are things that we can do to help you. Can we go and chat to [name of relevant staff member] about this as they know more about what support is available and how to access it?”
Ensure the young person is referred to a mental health professional for risk assessment and follow-up.
Who undertakes risk assessments?
A risk assessment should only be done by a mental health professional or a staff member with specific training, who has been allocated this role at the school.
Risk assessments offer an avenue to have an open conversation about suicidal thinking and help young people maintain a positive belief in their lives.
While risk assessments should only be done by trained professionals, any educator can check in with a young person about any perceived risk and should do so if they are concerned.
A suicide risk assessment brings together key information about a young person’s current mental state, any current or previous risk and protective factors, any key stresses contributing to the risk, and a review of current supports. It’s the combination of these factors and identified warning signs that contribute to their overall level of risk for suicide.
Some young people will talk about their suicidal thinking quite openly, while others will need encouragement to share these thoughts.
Often a starting point is to say, “With all this going on, have you ever felt like life’s not worth living — is this something that you’ve considered recently?”
Other options include:
“Do you ever feel like giving up?”
“How does your future seem to you?”
“Does your life ever seem so bad that you wish to die?”
“How often do you have these thoughts? How intense are they?”
“Have you made any plans? If so, what have you been thinking about?”
“How close have you come to doing something?”
“What stops you from doing something?”
If a young person is thinking about suicide it is important to directly ask them “are you planning on ending your life or to die by suicide?” as this is vital in planning for the next steps and the urgency of the intervention needed. The risk assessment then focuses on how frequent, distressing and persistent these thoughts are, if they have a plan, and if they have the means to follow through on their plan. An understanding of any previous attempts is also important to know as part of the risk assessment.
While we can never be sure who or why someone will attempt to end their own life, knowing the risk factors and warning signs can help us to identify and assist those young people who are most vulnerable.
Deciding what supports are needed
The outcome of the risk assessment will guide what support options are required immediately to maintain a young person’s safety. It may also suggest additional support to put in place over the coming days and weeks.
Options for consideration include:
- an urgent mental health assessment
- a non-urgent appointment with a health professional
- creating a Safety Plan
- ongoing support from the GP
- increased community and peer support
- or a combination of one or more of these things.
Where there’s any doubt about the level of risk, the local crisis mental health service should be contacted for consultation and follow-up.
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Bibliography
Cox, G., Robinson, J., Bailey, E., Jorm, A., Reavley, N., Templer, K., Parker, A., Rickwood, D. & Bhar, S. (2015). Responding to suicide in secondary schools: a Delphi Study. Melbourne: headspace National Youth Mental Health Foundation.
Mental Health First Aid Australia. (2014). Suicidal thoughts and behaviours: Mental Health First Aid Guidelines. Melbourne: Mental Health First Aid Australia.