Joanna Johnson, Associate Trainer (Grassroots Suicide Prevention), ASIST Trainer (Applied Suicide Intervention Skills), Papyrus Volunteer (Prevention of Suicide in Young People), and Head of Department and Psychology Teacher, Monmouth School for Girls, UK
If you were asked what the leading cause of death was in young people, what would you say? Drugs or Alcohol? Car crashes? Gang fights or violence in the home? It’s actually death by suicide. Alarmingly, around 4 children a week, some only 10 years old, die by suicide in England and Wales (ONS, 2022), with research by Papyrus in 2017 stating that on average students are sharing suicidal thoughts with teachers once a term or more (Papyrus, 2017). This may well have increased following COVID-19 and the cost-of-living crisis.
Child and Adolescent Mental Health Services (CAMHS) are overwhelmed, with many children and young people with mental health issues desperately needing support. Over 190,000 0–18 year-olds were referred to children and young people’s mental health services between April and June in 2021, up 134 per cent on the same period the year before, and 96 per cent on 2019 (97,342) (Royal College of Psychiatrists, 2021). Moving forward, the longer-term impact of the pandemic on young people is still being examined, however research from Cambridge indicates that ‘increases in stress across the entire population due to the coronavirus lockdown could cause far more young people to be at risk of suicide than can be detected through evidence of psychiatric disorders’ (Polek et al., 2020). It is so distressing and we, as teachers, give our absolute best to help our pupils. But we are not mental health professionals, and it can be frustrating when we can’t refer them for the specialist support they so desperately need.
On 13 March 2023, Parliament debated whether suicide prevention should be a compulsory part of the school curriculum (House of Commons, March 2023). Minister for Schools, Nick Gibb MP, responded to the debate and outlined current measures to ensure pupils’ emotional wellbeing within the curriculum: ‘as part of taking a comprehensive, evidence-based approach, we will make sure we speak to the experts in the field. We plan to start the review as soon as possible.’ If this does come to fruition, it could have a profound impact on rates of suicide in children and young people. But we must also examine what this means for us in our role as educators, how we embed this in the curriculum, and how we support pupils in the most effective way, with the most useful training.
Suicide is such a complicated and difficult area. The ripple effect of the death of a child or young person is of course unsurmountable, and research by Clinical Psychologist Julie Cerel shows that, on average, around 135 people are affected when a person dies by suicide (Cerel et al., 2018, p. 5). This figure, however, is erroneous when considering the impact on a community, as it depends on the connections in that community, and in particular such a close-knit community as a school.
I trained a group of counsellors and trainee counsellors on suicide prevention in South Wales – an area that suffered a particularly devastating 26 deaths by suicide in 2007/2008 (Luce, 2012). Many of the suicides were teenagers aged between 13 and 17 years. The community was shell-shocked and there was public outcry to try and find out why, with many blaming the media. There are now helpful media guides when reporting suicide, compiled by the Samaritans (see resources section), but suicide is a complicated issue, signified by a complex interplay of genetic, biological, psychological and social factors, so it is not wise to take a reductionist view of the causes, or the ways in which to help.
So, what can we do?
Tailored training which equips people to run an intervention with a young person is the ideal. And there are a number of courses I would highly recommend, in particular the ASIST Course, delivered by Grassroots Suicide Prevention, which I deliver (ASIST key studies 2007 – 2017). ASIST is a 2-day intervention course designed to equip people with a practical, credible model based on psychological concepts and extensive research. Not only does it provide a clear structure for educators to follow, but also offers the opportunity to apply the model to scenarios tailored to your environment/specific role in school. The intervention training will develop your confidence when holding conversations with a young person experiencing thoughts of suicide, and in developing a suicide safety plan.
In addition to ASIST, there are organisations, such as Grassroots Suicide Prevention, who will devise tailored suicide prevention training programmes aligned with your needs. There is an award-winning StayAlive App – see resources section (Grassroots Suicide Prevention, 2020) – which is packed full of information to help someone stay safe, whether they are having thoughts of suicide or concerned about someone else who may be considering suicide.
If you are interested in suicide prevention training, then please do not hesitate to get in touch. In the meantime, however, here are some key strategies to help, which are based on psychological models and key research studies.
Turning to some common misconceptions, it is often assumed that asking about suicide somehow puts the idea in their head. No research has shown this. In fact, it can have completely the opposite effect and act as a protective factor (O’Connor 2021, p. 52). If asked clearly, and directly, it can actually encourage the person to seek the help they so desperately need. An effective way to integrate this into the school community is to practise asking the question. This could form part of inset training for staff on mental health which incorporates a workshop on suicide prevention and could be run by accredited organisations such as Grassroots or Papyrus.
Another perception of people who have suicidal thoughts is that they want to die. This is not necessarily the case. Part of them will want to live and through an intervention, you can work with the young person to identify this will to live (O’Connor 2021, p. 53). The main emotion they often feel is ambivalence, plus ‘tunnel vision’ where they can’t see any other way out and feel ‘trapped’. The eminent Psychologist Edward Schneidman spoke of ‘cognitive constriction’ which is a narrowing of perspective, a dangerous reduction of the person’s range of problem-solving options, and a form of ‘psychological myopia’. The individual focuses on day-to-day needs at the expense of forward thinking (Jobes and Nelson 2006, p. 5). If a young person starts speaking about the future or anything that has meaning for them, such as family or pets, encourage that conversation, as it can be a connection to life, which can lead to a way out of this ‘narrow thinking’ process.
In your school community, your pastoral leads are undoubtedly dealing daily with children and young people with mental health issues. According to the 2022 Digital NHS report into Mental Health of Children and Young People in England (NHS Digital, 2022), 18 per cent of children aged seven to 16 years, and over 1 in 5 (22 per cent) of young people aged 17-24 years had a probable mental disorder, with many of these vulnerable young people more likely to report self-harm (28.3 per cent of 7-16 year olds and 68.6 per cent of 17-24 year olds with a probable mental disorder had tried to harm themselves).
According to the Royal College of Psychiatrists, self-harm is the single biggest indicator of suicide risk and provides a crucial opportunity for intervention. People with a history of self-harm are at increased risk of suicide, and self-harm is increasing in young people, particularly girls, according to the Incidence, clinical management, and mortality risk following self harm among children and adolescents report published by the Royal College of Psychiatrists (2017). Every mention of self-harm should be taken seriously, but the link between self-harm and suicide is not straightforward.
According to the Child Mind Institute (2023), self-injury can be used to feel better rather than to end life. Indeed, some people who self-injure are clear that it helps them to avoid suicide. They state that there are marked differences between self-injury and suicide, such as intent, means, frequency, level of damage caused and the amount of psychological pain experienced (Child Mind Institute, 2023). In essence, however, self-injury is a risk factor, especially when combined with other risk factors, such as a history of trauma, alcohol or substance abuse, adverse childhood experiences, childhood abuse, attachment disorder and high emotional sensitivity, as well as mental disorders and previous suicide attempts, according to research on Suicide and Youth: Risk Factors (Bilsen, 2018). The advice: hear their story, ask the question – are they thinking of ending their life?
So, what are we looking for?
What contributory risk factors and behaviours should you look for, monitor and follow up? Changes in language can be a sign, such as being a ‘burden’ to others, that they are ‘trapped’, ‘struggling to cope’ or ‘they’ve had enough’. Behaving out of character, such as giving possessions away, stopping clubs/activities, mood changes – either withdrawn, or elation (they can feel relief). A traumatic life event, such as bereavement, abuse, relationship or family breakdown. Unsurprisingly, academic pressure (especially exam pressure) is a risk factor, and they may express suicidal ideation verbally, or through indirect means, such as creative writing. Self-harm mentioned alongside a risk-taking behaviour is an important indicator. This list is not exhaustive, but knowing students well can help to identify behaviours that may be ‘out of the ordinary’, acting as a warning sign (see NSPCC Guide in resources section – learning from case reviews).
Issues around sexuality can be a risk factor. Stonewall’s LBGT in Britain – Health Report (Stonewall, 2018), based on YouGov research with 5000 lesbian, gay, bisexual and trans (LGBT) people across England, Scotland and Wales about their life in Britain today, found that half of LGBT people (52%) said they’d experienced depression in the last year, and one in eight LGBT people aged 18-24 (13%) said they’d attempted to take their own life in the last year. Almost half of trans people surveyed (46%) also thought about taking their own life in the last year, and 31% of LGB people who aren’t trans said the same.
Importantly, though, take every small mention of suicide seriously. You don’t need to solve all their problems; just listening and showing you care can really help. An important message that has come across in many training sessions I’ve attended, is to reverse the phrase ‘attention-seeking’ to ‘seeking attention’ – they are asking for help for a reason. You don’t need to have all the answers or be concerned about saying ‘exactly the right words’; just be that person they talk to, and show compassion.
One of the most effective strategies that I’ve learnt throughout all the training sessions I’ve attended/delivered, is the importance of listening. As teachers, we frequently want to jump to a solution in order to help, and I had to learn to put the brakes on and let someone simply tell their story. The story that is painful, the story that may be aired for the first time, the story that gives some release to that young person in psychological pain, the story that may save their life.
So, how can we embed this in the curriculum?
These are some suggestions, certainly not exhaustive, nor prescriptive. In addition, Papyrus has produced a helpful guide for supporting schools and colleges to be ‘suicide-safe’ (see resources section). We can all potentially help to save lives, by involving the whole community and empowering people to have conversations with children and young people, and to listen.
- Develop a School Suicide Prevention Policy (is suicide prevention in your School Development Plan?)
- Working groups, or a suicide prevention specialist intervention team (you may already have a Wellbeing Working Party that could incorporate suicide prevention)
- Involve a range of people: e.g. governors, SLT, safeguarding/pastoral/wellbeing leads/local authority/health boards, public health/nursing/boarding/parents/pupils/key local organisations/Papyrus/Grassroots.
- Training for colleagues (a cross-section of professions in the school community – not just teachers) during inset/suggested as CPD
- Do you have ‘safeguarding hubs’ in the community – could training be delivered to key people from several schools? (which would potentially save costs and reduce cover requirements)
- Incorporate in your PSHE programme
- Incorporate in mentor training for prefects, and/or enrichment programmes. Do you have wellbeing or mental health prefects?
- Enhance current safeguarding reporting methods: e.g. do pupils have ‘go-to’ people they can easily talk to – identify any barriers to them speaking to someone about their concerns
- Compile a ‘flow-chart’ of immediate action/key contacts to ensure colleagues know exactly what to do if they are concerned about a child or young person who has expressed suicidal thoughts
- A list of key organisations – both local to your community and UK-wide – with relevant helplines, accessible for everyone, including parents (you may wish to include a statement that you are not responsible for the content)
- ‘Help’ cards (credit-card sized), or ‘Help’ apps for students – with key contact numbers etc.
- Get involved with Suicide Prevention campaigns e.g. fundraising events, to raise awareness and reduce stigma
- Audit what you currently do in school – there will already be good practice taking place
- Audit your current reporting systems and run through potential scenarios to ensure they are fit for purpose.
It is, I know, so difficult in our profession. We are constantly holding fleeting conversations in corridors, or in the staffroom, rushing to meet deadlines and planning ahead. But if you can pause, just for a moment, and take the time to ask (you may have noticed a risk factor), listen, really listen, to that child or young person. There may be a chance for a turning point you spot, perhaps where they speak of hope, or you help them to identify a connection to life. It can work. You can save lives.
Suicide prevention: Useful resources and links
Grassroots’ award-winning app StayAlive, packed full of useful information to help you stay safe. You can use it if you are having thoughts of suicide or if you are concerned about someone else who may be considering suicide. In addition to the resources, the app includes a safety plan, customisable reasons for living, and a life box where you can store photos that are important to you.
Papyrus’ Building Suicide-Safer Schools and Colleges A GUIDE FOR TEACHERS AND STAFF.
Papyrus also runs a free helpline, which you can give to the young person to call, use for support during a conversation with a young person, for a debrief after an intervention, or any time you need advice on suicide prevention for children and young people.
HOPELINEUK: Call: 0800 068 4141, Text: 07860039967, Email: firstname.lastname@example.org
Opening hours: 9am – midnight every day of the year (Weekends and Bank Holidays included)
Samaritans 116 123 (available 24 hours)
Research evidence shows that certain types of media depictions, such as explicitly describing a method, sensational and excessive reporting, can lead to imitational suicidal behaviour among vulnerable people. In contrast, coverage describing a person or character coming through a suicidal crisis can serve as a powerful testimony to others that this is possible and can encourage vulnerable people to seek help.
NSPCC Suicide: learning from case reviews