|Preventing Suicide: A Resource for Teachers and other School Staff (WHO, 2000, 34 p.)|
Identification of distress
Any sudden or dramatic change affecting a childs or adolescents performance, attendance or behaviour should be taken seriously,18 such as:
· lack of interest in usual activities;
· an overall decline in grades;
· decrease in effort;
· misconduct in the classroom;
· unexplained or repeated absence or truancy;
· excessive tobacco smoking or drinking, or drug (including cannabis) misuse;
· incidents leading to police involvement and student violence.
These factors help to identify school students at risk of mental and social distress who may have thoughts of suicide that ultimately lead to suicidal behaviour.19
If any of these signs are identified by a teacher or school counsellor, the school team should be alerted and arrangements should be made to carry out a thorough evaluation of the student, since they usually indicate severe distress and the outcome may, in some cases, be suicidal behaviour.
Assessment of suicide risk
When assessing suicide risk, school staff should be aware that problems are always multidimensional.
Previous suicide attempts
A history of previous suicide attempts is one of the most significant risk factors. Young people in distress tend to repeat their acts.
Another major risk factor is depression. The diagnosis of depression should be made by a physician or child/adolescent psychiatrist, but teachers and other school staff should be aware of the variety of symptoms20 that form part of depressive illness.21
The difficulty of assessing depression is linked to the fact that the natural transitional stages of adolescence share some features with depression.
Adolescence is a normal state, and during its course such features as low self-esteem, despondency, concentration problems, fatigue and sleep disturbances are common. These are also common features of depressive illness, but there is no cause for alarm unless they are lasting and increasingly severe. Compared with depressed adults, the young tend to act out, eat and sleep more.
Depressive thoughts may be present normally in adolescence and reflect the normal development process, when the young person is preoccupied with existential issues. The intensity of suicidal thoughts, their depth and duration, the context in which they arise and the impossibility of distracting a child or adolescent from these thoughts (i.e. their persistence) are what distinguishes a healthy young person from one in the throes of a suicidal crisis.
Another important task is to identify environmental situations and negative life events, as outlined previously, that activate suicidal thoughts and thus increase suicide risk.