Screening for Suicide
When students are depressed or overwhelmed, their thoughts can turn to suicide -- at least as an idea. According to the CDC and the American Association of Suicidality, we know that in 2005 there were about 4,212 deaths in the United States among young adults age 15-24 that were ruled suicides by coroners.
In addition, it's estimated that for every completed suicide there are up to 100 attempts in a young adult population, and many more students who experience suicidal ideation. In fact, suicide is among the top three causes of death for college students.
In retrospective studies of those who committed suicide, it's been shown that most have communicated their intent to others in some way.
That's why it's so important for those who intervene with students to become comfortable asking about suicidal thinking and activity. Some students may feel hopeless and not consider seeking mental health services without your urging. You can literally save a life by asking and following up.
Many life events and situations put students at increased risk to consider suicide:
- Previous suicide attempts for self or significant others in their lives
- Psychosis or dementia or any condition that impairs a person's sense of reality
- Impulse control problems
- A major loss or anniversary of a loss
- Maladaptive personality problems
- Unsuccessful medical treatment or diagnosis of a serious illness (such as HIV or cancer)
- Recent physical trauma such as athletic injuries
- Rape or sexual assault or other trauma
- Drug and alcohol abuse
- Long term family problems/Difficult life history
- Social and emotional isolation
- Almost anything the person perceives as overwhelming or stressful
- Access to guns or materials that can be used for suicide
It's okay to talk about it
If you have any concerns about whether someone is suicidal or feeling out of control, don't be afraid to ask them about the risk of danger to themselves or others. It's a myth that you will "plant the idea" by asking. In fact, you are more likely to find that students are relieved to know that you're taking them seriously and that the idea is out in the open for discussion.
If a student isn't thinking of suicide they are often quick to reassure you of that fact, which can help you to relax about the emergency need for intervention and help you feel it is safe for the student to be alone.
These are general guidelines for talking about suicide:
Ask DIRECTLY if the student is having serious suicidal thoughts and feelings.
A Suicide Lethality Assessment focuses on how involved and detailed the person's suicidal thinking is and how deadly the proposed method is.
Some questions you might ask:
Does the person have a plan or method?
Do they have access to the means of their plan?
Do they have a time or event in mind that will trigger the suicidal action?
Do they truly intend to act on their ideas?
Is the person feeling hopeless? helpless?
Are there other risk factors or events that might lead them to have difficulty resisting suicidal action?
For instance, are they suffering from major depression and also experiencing a major loss in their love life which is affecting their academic performance so they can't visualize a future?
A sense of tunnel vision and no ability to see the future is often associated with suicidal thinking and behavior.
Examples of how you might ask the questions are:
When you think of suicide does it get to a point where you think of how you might do it?
Is this method available to you? i.e., Do you have the pills or the gun?
Do you feel that you will truly act on this plan?
Do you feel hopeless and helpless about things changing for the better?
Try to involve the student in problem solving about their safety and impulse control:
What has kept them from acting on their suicidal thinking?
What supports do they have?
What are they willing to do if they do feel more suicidal and think they might act on it?
ASK: Do you think that you would be able to call a crisis line if your thinking became stronger and you might act on it?
Make referrals for Psychological care:
Some students will be immediately receptive to the idea, but others will need reassurance in order to feel okay about proceeding to see a mental health professional.
It's helpful if you can "normalize" the idea of a referral. Such as, "I know that the counseling center staff see thousands of students each year. Many of them are dealing with issues like yours."
If the student isn't suicidal, you can't make them seek services, but you can plant a seed to get them to think about it: "It seems like you are reluctant to seek services now, and it sounds like you feel confident that the situation will improve. I want to give you this information in case you feel you may need it in the future. You can also come back to see me if you change your mind and want to seek services."
It's important to escalate your referral efforts depending on the degree of danger.
At the lowest level, you might suggest counseling services. If you're more concerned about the student and fear they might not follow through, you may want to offer to schedule the appointment for them. At the most intense level of concern, you might want to walk the student over to the counseling center or they can be accompanied to the hospital emergency room to make sure that an intervention happens.
If the student says "Yes" to thoughts of suicide and has plans and a sense of imminence, DO NOT LEAVE THE PERSON ALONE. Get professional help immediately.
At SUNY Cortland, you can refer the student to the Counseling Center, (607) 753-4728 during daytime hours, 8 a.m. - 4:30 p.m. In the evening, there is a 24-hour Psychiatric Services Crisis Hotline through the Cortland Regional Medical Center, (607) 756-3771.