Suicide Cluster Prevention on Campus

12/03/2015

There is some evidence that after a young person dies by suicide, other youth may attempt the same thing. This may lead to “suicide clusters” – an unexpectedly high number of suicides that occur close together in time or space. But these tragedies are preventable.

That’s the message of a webinar called “Responding to Suicide Clusters on College Campuses ” cosponsored by SAMHSA and the Jed Foundation, a nonprofit organization dedicated to improving emotional health and preventing suicide among college and university students. The webinar was a response to recent suicide clusters at Tulane University and Appalachian State University, two recipients of SAMHSA’s Garrett Lee Smith Memorial Act Campus Suicide Prevention Grant program.

Understanding Suicide Clusters

Suicide is the second leading cause of death among college students, with an estimated 1,500 deaths each year, according to Madelyn S. Gould, Ph.D., M.P.H., a professor of epidemiology in psychiatry at Columbia University and the New York State Psychiatric Institute. Because college suicides aren’t officially tracked at the national or state level, she said, it’s hard to know beyond anecdotal evidence how often clusters occur.

What’s better known are the mechanisms behind suicide clusters – the process by which direct or indirect knowledge of a suicide facilitates subsequent suicides. One key factor is emotional suggestibility, said Dr. Gould, noting people’s tendency to identify with others, mimic their behavior, or even confuse other people’s emotions as their own. For students who have already contemplated suicide, she said, a peer’s suicide can “tip the balance” toward engaging in suicidal behavior themselves.

College students are especially vulnerable to suicide clusters, said Dr. Gould, explaining that they’re often away from their families for the first time and much more involved with peers. Plus, the part of the brain that helps control impulsiveness hasn’t fully developed yet

As a result, research shows a significant association between a peer’s suicide and subsequent deaths. “If someone in a peer group has attempted suicide or died by suicide, there’s a 3- to 11-fold increase in the odds that a friend will actually attempt suicide,” said Dr. Gould.

Media coverage also has an impact – both positive and negative. When the media focuses on coping strategies – like being active, reaching out for support, and volunteering – rather than suicide, said Dr. Gould, suicide rates decrease.

For this reason, SAMHSA, together with several other organizations, developed a guide,Recommendations for Reporting on Suicide. The guide equips media with practical recommendations for covering suicide in ways that can change public perceptions and correct myths. It also offers tips to avoid misinformation and lists the warning signs of suicide.

Sharing the News

On the flip side, media messages can increase vulnerable people’s risk and undermine prevention efforts, said Kerri Smith, L.C.S.W., M.P.H., senior campus prevention specialist at the SAMHSA-funded Suicide Prevention Resource Center .

“Pictures or detailed descriptions of how and where a person died can encourage imitation and serve as a how-to guide,” said Ms. Smith. Another common mistake is oversimplifying the causes of suicide, attributing it to single factors like break-ups or bullying. Romanticizing suicide or portraying it as common may also feed into a false perception for someone who may be struggling with suicidal feelings.

Language use matters too, said Ms. Smith. “Epidemic” suggests the problem is too big to solve, for instance, while “unsuccessful” or “failed attempt” imply that success equals suicide.

Several strategies can help campus administrators communicate safely and effectively:

Be prepared. Make a plan before you need it. Identify who will share news with the campus community and how that person will communicate. Create customizable templates, drawing on the sample announcement letter in the Higher Education Mental Health Alliance’s “Postvention: A Guide for Response to Suicide on College Campuses .” Decide what to do about memorial services. The plan should also include social media. To prevent the spread of rumors, post information about resources and monitor postings for unsafe content or cries for help. The “Online Postvention Manual ” created by the SAMHSA-funded National Suicide Prevention Lifeline offers additional tips.

Focus on the positive. “The vast majority of people who face adversity or who live with mental illness don’t die by suicide but instead find support, treatment, and other ways to cope – messages we want to focus on instead,” said Ms. Smith. The SAMHSA-funded National Action Alliance for Suicide Prevention offers a Framework for Successful Messaging with specific tips on how to shift the focus from the problem of suicide to concrete steps for helping yourself and others plus stories of successful treatment and recovery.

Build relationships with reporters. Share media guidelines, information about resources, and sample language with student reporters and local health and mental health reporters before a crisis occurs. If inappropriate coverage happens, contact the reporter or write an op-ed or letter to the editor.

Focusing on Prevention

Scott Tims, Ph.D., the assistant vice president for Campus Health at Tulane, wishes his campus had done all this before it faced four student suicides last year.

Instead, campus administrators – many of them new – struggled with how to communicate after the first suicide even as they sent out multiple emails announcing the university’s new stadium. “We had not in recent history had a completed suicide,” said Dr. Tims. “No one had that experience.”

Now the campus is ready to stop future clusters before they begin.

Building on its ongoing work as one of SAMHSA’s Garrett Lee Smith grantees and drawing on technical assistance from SAMHSA staff and others, the university added staff to its counseling center and organized support groups. It trained faculty and staff how to recognize and respond to problems and began offering webinars to parents to educate them about the resources available to students. It also launched a 24-hour hotline plus a social marketing campaign about depression and the resources available to treat it. The campus even offered case management services to close friends, checking in regularly to make sure they were coping all right.

For SAMHSA project officer Jennifer Cappella, M.P.A., it’s no surprise the university’s strategy helped stop the suicide cluster.

“There’s a saying in the field: Postvention is prevention,” said Ms. Cappella, a public health advisor in the Suicide Prevention Branch of SAMHSA’s Center for Mental Health Services. “If we can respond appropriately to these unfortunate situations, then we can, in theory, prevent other suicides in the future.”