Mental Health Information Centre

Introduction to Teachers Information

Teachers enjoy a unique role in the moulding and development of their students. It is unique in one sense - the teacher may never know the impact that he or she has had on a given student. Because it is difficult to ascertain the degree of influence, the teacher may falsely conclude that there is no influence, or very little, outside of intellectual skills; or our PE teachers might conclude that they have little influence outside of the development of motor skills. Whether you wish to admit it or not, we are constantly imparting affective skills.

Paradoxically, it is in the last area that teachers may feel insecure or may even deny having any influence. Our students need us in more ways than we can ever know. We need to teach them how to think, but we must also teach them how to deal with emotions. We need to teach them the accumulated wisdom of centuries, but we must also teach them to cope with the here and now. We must teach them about historical and literary characters, but we must also teach them to deal with the people in their environment. We must teach them the skills necessary to earn a living, but we must also teach them about death and dying. In order to teach them, however, we must learn ourselves.

We can no longer perceive our roles only as dispensers of knowledge. The students sitting in front of us are not mere receptacles for ideas, facts, values, trends, data, or events. Those sitting in front of us are caught up in the pressure-cooker of modern life. Students of all ages are sometimes seething with feelings that are incomprehensible, with a sense of helplessness, hopelessness, and no sense of the future. Setting a course in uncharted territory, their feelings may be emotionally debilitating, with ideas that confuse rather than clarify, and with demands that would defy Hercules. Just as adults can be overwhelmed so can students, and classroom activities may be the last thing they are thinking about.

Frequently Asked Questions

1. Why do people die by suicide?

People who die by suicide are often having intense feelings of helplessness and hopelessness and may not see any other way out of their emotional pain. It is important to remember that most people who attempt suicide do not really want to die. They simply want to end the pain they are experiencing.

2. Is it true that people attempt suicide as a cry for help?

The suicide attempt is quite often a conscious or unconscious method for getting others to recognise just how badly the individual is feeling. Yes, suicide attempts are very often cries for help.

3. If someone in a family has completed suicide, are other members of the family tempted to try suicide when they have problems?

If someone in a family has completed suicide, other family members may be tempted because suicidal behaviour has been "modelled' for them. However, suicide behaviours are not inherited in families.

4. Do people ever attempt suicide to "get attention" or to get others to feel sorry for them?

Anyone who attempts suicide in order to get attention desperately needs it. It is tragic when someone feels they need to bargain with their life in order to have their problems taken seriously. Any suicide attempt needs to be taken seriously.

5. If a person attempts suicide and fails, what is the likelihood of them trying again?

One of the important warning signs for suicide is a prior attempt. Anyone who attempts suicide once is more likely to try suicide again than those who have never attempted. However, many people who receive licensed professional medical and behavioural health care following a suicide attempt may never become suicidal again.

6. Is it true that people who attempt to kill themselves really don't want to die?

Many people who attempt suicide are ambivalent about life. They want to live and die at the same time. But, as noted in number 1, it is not that the person really wants to die, but rather that death may seem like the only way to end the emotional pain the suicidal person may be feeling. It is the pain they want to end usually, not the life.

7. Will a person who is deeply depressed always become suicidal?

While it is true that suicidal feelings often develop in a person who is deeply depressed, the fact that one is depressed does not mean that a person will become suicidal.

8. Does anyone ever impulsively try suicide and then become sorry for making such an attempt?

A person at a particular moment may find the emotional pain being experienced absolutely intolerable. At a given moment, a suicide attempt might impulsively be made which, in retrospect, might be regretted.

9. Does taking drugs or alcohol increase one's chances of becoming suicidal?

Taking drugs or alcohol in excess can exaggerate painful feelings to a point where the feelings become intolerable. In such a state, a person might attempt suicide who otherwise would not go that far.

10. Is a person who attempts suicide mentally ill?

All suicidal individuals are not necessarily mentally ill, though many people who attempt or complete suicide may have symptoms of mental illness, the most common being some form of depression. It is important to note that most depression is of a temporary nature and is treatable.

11. Is it true that gay teenagers are at higher risk for suicide than teenagers in general?

Studies in the US indicate that gay, lesbian and bisexual youth account for some 30% of all youth suicides, yet constitute only about 10% of the total youth population. Thus, it is clear that such youth are at much higher risk for suicide than the youth population as a whole.

12. How can one help a person who is suicidal?

A person who feels that life is too painful is often feeling very worthless, perhaps unloved, perhaps isolated Showing such individuals some real caring, by listening to them, accepting their feelings without judgment, by staying close, and getting others to be supportive, can really help. Giving time and really listening to someone in crisis is critical. It may be important to refer the person to a professional medical or mental health worker at some point.

13. How does talking about suicide help to prevent it?

Talking about suicide diffuses some of the intensity of suicidal feelings. It helps the person get connected to the help that may be needed. It creates a climate of caring and helps to break through the loneliness and isolation a person may be experiencing. By asking someone in crisis if they are suicidal, we give that person permission to talk about possible suicidal feelings, about which they may otherwise feel they cannot, or should not, talk about.

14. Is suicide or attempted suicide against the law?

At one time suicide or attempted suicide was against the law. In some countries it has only been within the last 20 years that suicide has ceased to be a crime.

15. What effects does a suicide have on the individual's remaining family and friends?

The survivors of a suicide are left with complex and often confusing feelings of rage, guilt, despair, grief, loss, shame, etc. Recovery from the loss of a loved one by suicide is a very difficult form of grief to resolve, and may never be completely resolved. It has been estimated that every suicide, on average, has a direct, profound emotional impact on 8 to 12 other people. With some 30,000 suicides each year in the EU, there are consequently a huge number of emotionally impacted "suicide survivors".

16. Why do some people keep secret the fact of a suicide in the family?

Some people keep the fact of suicide in the family a secret out of fear of being blamed or socially ostracized. Fortunately today, much of the historical stigma of suicide is lifting and people are dealing with suicidal death more directly and honestly.

17. What are the most common methods used by teenagers to attempt or complete suicides?

Lethal methods for attempting suicide by teenagers include guns, hanging, carbon monoxide, jumping, and drug overdoses. Auto accidents account for many deaths, but it is often difficult to determine whether the death is suicide or an accident.

18. Do more men or women make attempts on their lives?

Although about three times as many women attempt suicide than do men, about four times as many men complete suicide than do women. This is due to the fact that men use more lethal methods, such as guns or hanging, while women are more likely to attempt suicide by using pills.

19. Does everybody think about suicide at least once in their lifetime?

At some point in their lives, most people have at least fleeting thoughts of suicide, especially in times of personal crisis but it does not mean a person will die by suicide.

The role of education and Teachers

Reluctance to speak openly about suicide and the resulting taboos and myths about suicide predate the modern period.

Historical reactions to suicide have changed in accordance with religious, social, and legal changes in values. Suicide at various times has been considered socially acceptable, a moral evil, or a criminal act. Various societies have seen fit to mutilate the body of a suicide victim, ostracise surviving family members, or cast a shroud of eternal damnation on the victim.

Because of the historically negative reactions to suicide and its victims, guilt, emotional anguish, social embarrassment, self-blame, fear, and superstition still colour reactions to and about suicide.

As teachers, it is imperative that we challenge these historical taboos and myths and replace them with a learned approach to, and compassionate understanding of, those who suffer to the point of taking their own life.

Being human does not require specialised training. All we need is a compassionate, caring attitude, a non-judgmental understanding, and a willingness to listen, mixed with a basic knowledge of the causes, warning signs, and suicide awareness and prevention techniques.

The role of the teacher

The modern adolescent, bereft of any apparent solution to his problems and seemingly cut off from sharing his pain with another human being, may break under the pressure and opt for the most permanent solution - death. And who but teachers are in the best position to observe students individually or in groups, to sense the emotions seething under the surface, to monitor subtle changes in behaviour, and to realise that the student in reality might be a hurting human being?

But if the teacher lacks knowledge about suicide - its causes and its warning signs - the teacher very well could be unaware that a life and death drama might be developing. It is too late to rewrite the lesson plans of life once the student rips up the original copy. This is not meant to reduce teachers to a state of paranoia about suicide. The intent is to call the teachers' attention to the need for self-analysis about their own attitudes toward suicide and its victims, and to the need for an awareness of the signals that students may be sending out about their inner turmoil.

Chad Varan, founder of The Samaritans, put all our minds at ease when he argued that one doesn't need a degree or diploma to help another human being. He said, "What is needed to save another human being from death ... is a compassionate heart, the willingness to accept, to pay attention, to care." Who among our teaching staffs does not have these characteristics? We teach, so we care. All we need is knowledge that will direct our caring in the right direction.

In talking to teachers informally, we have learned that many of us are willing and ready to befriend our students. However, we are sometimes frustrated by a system that does not allow us the time and the freedom to sit and listen to our students who are crying out for help, acceptance, and love.

The following guide deals with death by suicide. Certainly not a very pleasant subject, but one that is confronting teachers in increasing numbers. We know the agony and inner panic when faced with young persons who have chosen to die at their own hands or who are contemplating the "ultimate solution" to life's problems. Teachers themselves are not immune to suicidal thoughts and wishes. The following guide is meant primarily to bring information to the teaching community so we can get to grips with this pervasive problem and to ease ourselves into the role of suicide prevention through increasing awareness and, as importantly, through the development of a skill called "Active Listening".

Some of the underlying causes of youth suicide and self-harm

Much work has been done to try to clarify the reasons why young people kill themselves. We know that young people who are depressed are more likely to go on to complete suicide, but it is important to state that it is still only a relatively small percentage. It is also the case that drug and alcohol misuse is certainly more common in those who die by suicide.

Drugs and alcohol tend to have a two-fold effect. The first is that they, in time, act as a depressant, making low mood more likely. The second is that they tend to decrease inhibitions, and therefore remove the internal controls whereby one prevents oneself from engaging in self-harm or suicide. It is also important to be aware that drug and alcohol misuse can be a marker, in any young person, for increasing levels of unhappiness or distress. It is not unusual for those who are unhappy to turn to drugs or alcohol to give themselves a lift, but, as has been mentioned, the effect is short lived and is replaced by a further deterioration in mood. When young people self-harm, they give a variety of reasons, but certain themes quickly emerge. The most common of these is the break-up of a relationship, or other peer difficulties.

Another common situation is difficulties at home within the family, and such difficulties can either be of longstanding duration or acute. Less frequently young people describe a build-up of pressure, either academic or otherwise, which generally leads to mounting levels of tension and stress and a feeling that a young person cannot cope. If this happens in the context of a personality which is somewhat perfectionistic and rigid in nature, where a young person does not allow themselves the option of “failure”, the result can be catastrophic because a young person’s problem-solving competence in such situations becomes significantly impaired, as does their list of possible remedies.

This issue of problem-solving difficulties is a recurrent one in young people because in many cases of self-harm a young person’s ability to generate an alternative solution is defective. This happens for a variety of reasons.

The first of these is that, for many young people, their ability to put words to their feelings is at a relatively undeveloped stage. Even though we live in an age where psychological terminology is far more part of the common usage than it was in the past, there is still often a gap between a young person’s awareness of the meaning of a term and their ability to apply it to their own situation. Young people discover, as this ability improves, that they can develop some sense of control by being able to articulate their own internal world, and their developing capacity for abstract thought allows them to discuss these topics in a different way. It is also important to remember that our brains work in a way that makes it more difficult for us to think creatively and flexibly about a difficult situation if we are emotionally aroused. Our ability to generate solutions, to estimate risk, to predict the responses of others, and to manage ourselves through such difficult situations is never as good when we are agitated or distressed as when we are calm. We tend to “catastrophise” whereby we imagine the worst possible outcome and therefore react, which can involve self-harm. Self-harm also develops as part of an on-going pattern. While it may start in a situation where people feel acutely distressed, it often becomes a means of regulating one’s levels of discomfort. Hard though it is to believe, young people who cut themselves while highly distressed describe, not a sense of pain, but a sense of relief. There are many theories as to why this may happen, but fundamental to understanding this dynamic is to realise that, for a young person, cutting themselves may not always be a painful or a distressing act.

Essentially, young people harm themselves (either by cutting or by overdosing, or by drug or alcohol misuse) to get rid of unpleasant feelings. It can create a cycle whereby they believe that the only way to get rid of such feelings is to carry out that specific act, and a pattern ensues. That is the reason why many people who harm themselves on one occasion go on to repeat such an act. It is by no means always a suicidal gesture, and while a very unhelpful way of coping, must be seen in context. In this regard, cutting is the most common method of self-harm which becomes repetitive.

Overdoses tend to be more serious, and are far more likely to have lethal intent. Hanging and choking are almost always lethal with respect to intent and must be taken very seriously. The one exception to this is that many young children, either in their early teens or perhaps younger, can engage in either breath-holding or asphyxiation games in order to induce an altered state of consciousness. While this does not, generally, have lethal intent, it is quite likely that, in situations where people carry this out alone (by using a ligature) they may be unable to release the ligature in time, and this has led to loss of consciousness, and even death.

Warning signs and behavioural changes

While suicide is, by its nature, a terminal act, one must be vigilant for the tell-tale signs of a lowering of mood or of other at-risk behaviours. Unfortunately, not every incident of suicide can be predicted, as, even with the benefit of hindsight, it appears clear that some young people tragically kill themselves in an impulsive manner which could not have been foreseen, even by their nearest and dearest. However, it makes it all the more important that we pay very close attention to signs of depression or increasing impulsivity which can lead to timely interventions where appropriate.

Depression is a condition which previously had been considered unusual in teenagers and vanishingly rare in pre-teens. We now know that the incidence of depression, while uncommon, is very much a concern in pre-teens, and rising through adolescence. It is more common in girls than boys, and its incidence increases with age, until it reaches adult levels.

Depression is characterised by low mood, increasing irritability, social withdrawal, poor concentration, and is often accompanied by alterations in sleep pattern and appetite. The thinking patterns which are common in depression are self-critical, finding fault with many things, pessimistic regarding the future and discounting anything which may appear to be of value or benefit to the person. Essentially, it is the very opposite of “rose tinted glasses”.

While most cases of depression are mild to moderate, and resolve within a month or two, some cases become more serious. Teenagers with depression create difficulties for themselves by virtue of their irritability, their deteriorating school performance, their social withdrawal and their resultant behavioural difficulties and lack the flexibility to get themselves out of such situations, because of their low mood. Therefore they can become alienated from family, and sometimes from their friends.

For teenagers, who take so many of their values and their points of reference from their peer group, to fall out with friends, particularly when they have already fallen out with their families, causes huge difficulties, thereby perpetuating and indeed deepening the cycle. In such cases, particularly when teenagers become agitated and angry, self-harm is often an accompanying concern.

One can see, for such teenagers, how drugs or alcohol might offer a temporary reprieve. Nonetheless, it remains that most episodes of drink and drug use by teenagers is of an experimental type, at least initially, and then often part of a peer activity. It is certainly not the intention to make excuses for it, but merely to point out that it is common, and it is usually not associated with mental illness.

Many teenagers, especially boys, are quite impulsive by nature. This can often be seen in the context of young people with ADHD (Attention Deficit Hyperactivity Disorder) but is not restricted to this. For such teenagers, who struggle with deferred gratification, the likelihood of an impulsive act of self-harm is greater than for the general teenage population.

While in some ways such acts are more easily excused, and indeed occasionally explained away because of the impulsivity, when one thinks further about it, one realises that the level of impulsivity actually makes it more difficult to plan prevention strategies compared to those whose acts of self-harm are the result of the more protracted planning.

General Warning Signs of mental health issues

If someone is seriously depressed and/or thinking of attempting suicide there are often warning signs that family and friends can pick up on. Noticing and acting upon these warning signs could save a life. Most people who are dealing with mental health issues, or considering suicide, are willing to talk about their problems if someone shows they care. Don’t be afraid of discussing these subjects with someone you think may be in crisis. Talking about emotive issues or even suicide won’t ‘plant the idea’ in someone’s head. This is a myth. If you are wrong, you’re at least showing a friend you care. If you are right, you could save their life.

Sometimes stress or a traumatic event like bereavement can trigger depression or even suicidal thoughts in a vulnerable person. For this reason it’s important to ask teenagers who are going through a tough time how they are coping and if they need some support. Having someone to talk with can make all the difference.

Warning signs can include but are not limited to:

• Withdrawing from family and friends.
• Having difficulty concentrating and thinking clearly.
• Sleeping too much or too little.
• Feeling tired most of the time.
• Gaining or losing a significant amount of weight.
• Talking about feeling hopeless or guilty.
• Talking about suicide or death.
• Self-destructive behaviour like drinking too much or abusing drugs.
• Losing interest in favourite things or activities.
• Giving away prized possessions.
• Mood swings.

Additional warning signs that a teen may be in crisis:

• Change in eating and sleeping habits
• Withdrawal from friends, family, and regular activities
• Violent or rebellious behaviour, running away
• Drug and alcohol use
• Unusual neglect of personal appearance
• Persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
• Frequent complaints about physical symptoms, often related to emotions, such as stomach-aches, headaches, fatigue, etc.
• Not tolerating praise or rewards

IMPORTANT NOTE

If someone mentions suicide, take it seriously. If they have expressed an immediate plan, or have access to prescription medication or other potentially deadly means, do not leave them alone. Get help immediately.

Basic guidelines on how to help

When an adult becomes aware of a young person’s emotional distress or their self-harm, it comes about either because an adult has, through vigilance or information received, developed an opinion that a young person is at risk, or else a young person has taken the initiative in discussing their concerns with an adult.

Firstly, it is worth considering what the qualities are in an adult that makes a young person feel they can confide in them.

Tolerant and accepting

The issue of stigma regarding psychological difficulties is one which has been widely discussed, and is very much seen as a barrier to intervention. Young people are far more likely to approach those whom they know have a tolerant and accepting attitude towards psychological difficulties rather than those whom they perceive to be disparaging or intolerant of such problems. Therefore, the way in which one discusses or talks about psychological problems already sets the scene for whether or not a teenager is likely to approach in case of difficulties.

Respect

Another significant point is the central importance of the respect which the adult shows to the young person. It cannot be over emphasised that for a young person to describe their own internal world at a time when they feel close to crisis takes a huge amount of courage, and the response of the adult is crucial.

Not judging or trivialising

The most important aspect is to listen carefully and calmly without judging and without jumping to conclusions. Not only must the adult respect the young person, but they must also respect their account of their difficulties. In other words, one cannot trivialise the symptoms, cannot say, in a dismissive way, that everybody experiences such symptoms, or indeed that the young person has much to be thankful for and aren’t there those who have much greater difficulties.

Allow the young person to talk

It is not a time, when listening to a young person’s story, for drawing premature conclusions or cutting them short. The young person is the expert in their own story. It is also worth remembering that young people, in describing such symptoms, may not always feel ready to describe their most pressing concerns, and often, especially if there are particular on-going stressors, may provide a “test case” of such difficulties in order to see how the adult responds.

Don’t guarantee confidentiality

In situations where young people describe episodes of abuse, either physical sexual or emotional, it is absolutely critical that the adult does not give a guarantee of confidentiality to the young person, however much the young person seeks it. To do so, while often based on compassionate grounds, serves to compromise the adult, to undermine the rights of the parent, and indeed on occasion to thwart due process (when the issue is more appropriately dealt with by the civil authorities).

Listening

In a situation where an adult forms the impression, either from their own observations or from information passed on from others, that a young person is particularly low in mood, or at risk of self-harm or indeed suicide, an approach needs to be made to the young person.

It may well be that the adult who has formed the impression is the best person to do so, or perhaps there is another adult with a more developed relationship with the young person who might be more appropriate. In either event, once the initial approach is made, the importance of listening empathically and without judgement to the young person’s answers is critical.

Discussion does not cause suicide

There is a diminishing, although unfortunately still prevalent, mistaken belief that discussing the topic of suicide is merely implanting this into the young person’s mind. This is not true.

It is important that, in situations where it appears that it needs to be asked, the adult does not shy away from asking very specifically about whether or not the young person feels their life is no longer worth living, whether or not they have in any way harmed themselves in the past, or whether they have plans to do so in the future. It is crucial that the adult can tolerate the young person’s distress, because this is very containing and comforting for the young person.

Under 18s

In either event, if one is dealing with a young person under the age of eighteen, it is essential that the young person’s parents be first informed. The one exception to this is if there are sufficient grounds for concern that a young person has been the victim of some form of abuse at home and that his or her parents may not have the young person’s best interest at heart, then one should approach the civil authorities, most often the HSE Child Protection Team.

Getting support

However, in the more usual situation, it is important that young people can be reassured, in so far as possible, that their feelings are both validated but also that help is available, and that advice can be given on whom to contact.

In situations where there is a level of unhappiness without any concern regarding self-harm or suicide, then there may well be people locally, either within schools, youth clubs or other organisations, who can support the young person. If there are concerns regarding self-harm or significantly lower mood, then parents are best advised to discuss matters with their family G.P. who will know both the family history and also the range of appropriate local options.

Helping students – Do’s

• Do befriend when appropriate
• Do consider the possibility of suicide
• Do focus on the pain
• Do ask if suicide is on their minds
• Do get involved
• Do allow them to express feeling
• DO LISTEN
• Do make life an option for them
• Do be non-judgmental
• Do get help and support for yourself as well
• Do stay with the person at risk

Helping Students – Don’ts

• Don’t lecture or moralise or give advice
• Don’t think it is a passing phase
• Don’t brush off feelings with inane remarks
• Don’t be afraid that you will instil the idea
• Don’t do nothing
• Don’t trample on feelings
• DON’T TALK TOO MUCH
• Don’t dare them to follow through with suicide
• Don’t react verbally or physically with shock
• Don’t go it alone
• Don’t leave the person alone
• Don’t promise not to tell anyone

If you cannot help a student

So what happens if a student comes to talk to you and you are just not comfortable with the idea; you might not be in a good place yourself; you might feel it isn’t appropriate; or you just might not relate well to the particular student. For some reason we have noticed that students will often come looking for support from teachers who they have the most confrontation with, which may be because they perceive that teacher as strong or they might even be seeking “permission” to talk about something that is bothering them.

If you find yourself in a position where a student wants to talk with you and you cannot help them then there is some guidance available:

1. Bear in mind that the student may have a serious issue to report
2. Don’t let the student start telling you the problem and then cut them off.
3. Be upfront that you can’t assist and tell them why, gently.
4. Tell the student who can assist them.
5. Take the student to that person; don’t just send them off. That can be seen as rejection.
6. The student came to you for a reason; offer to stay with them while they talk to the other teacher or counsellor.
7. Make sure that you report the fact that the student came to see you so that there is a record.
8. Always follow your school’s child protection policy.

Fighting stigma

One of the most positive influences we can have is by fighting stigma. There is still a huge amount of stigma attached to suicide, and this can be further instilled by religious or moral teachings.

Some teens have given us feedback that when they wanted to visit a friend who had attempted suicide they were actively discouraged by some parents from doing so; although the same parents had been encouraging their teens to visit a young teen from their school who had been diagnosed with leukaemia. The teens couldn’t see how the situations differed but they were being given different advice.

None of us are perfect, and we all have prejudices, but it is so important that we allow our teens to develop their own attitudes to issues which challenge them, their friends and peers. This is particularly the case with suicide, where we often still see the young person who has lost their way and tried to end their suffering treated as a perpetrator rather than a victim probably most clearly highlighted in the continuing common use of "committed suicide" rather than the much less nuanced "died by suicide".