Services aimed at intervention focus on improved detection, assessment, and management of young people at risk for suicidal behavior. The hope of these strategies is to reduce the severity of behaviors or life events that may lead to vulnerability. Organizations that may become involved at this stage are: schools, court systems, medical and mental health services, and crisis services.
School Gatekeeper Programs
School gatekeeper programs are directed at school staff to help them identify students at risk and refer them for help. These programs also teach staff how to respond in case of a crisis in the school. A "gatekeeper" can be anyone who is in a position to interact with students during the course of the school day, such as coaches, teachers, cafeteria staff, custodians, and counselors. School gatekeeper training is meant to enable staff to "sound the alarm." It is not meant to replace professional mental health counseling, but combined with professional treatment, it may help prevent suicides. (CDC, 1992)
Gatekeeper programs may "help school staff recognize and take action to reduce sources of stress in the social environment of the school system." (Caplan, 1964, Kelly, 1979, as cited in CDC, 1992) These programs may also help "to develop relationships with students at times of transition or vulnerability that can help them in their subsequent functioning." (Hersey, 1977, as cited in CDC, 1992)
PNSAS The Pennsylvania Network for Student Assistance Services (PNSAS) is a gatekeeper program that has been in effect in Pittsburgh for twelve years. The targets of the program are all secondary level schools in all school districts. In 1992, 500 of the 501 school districts in Pennsylvania had representatives who had completed training in student assistance, which means 1,039 schools had representatives trained at that time. (CDC, 1992) The resource guide published by The Centers for Disease Control (1992) describes the Student Assistance Program (SAP) in effect in Pennsylvania:The . . . SAP focuses on early identification, intervention, and referral of at-risk students to community resources for assessment and treatment. A SAP core team . . . consists of six school personnel trained to identify and refer at-risk students to community resources. SAP team members do not diagnose or offer treatment to students; instead, they refer them to appropriate community assessment and treatment resources. There is a direct link between schools and local mental health and drug and alcohol service providers.
The team members attend a residential training course which includes: two days of lectures; two days of practicing and role-playing; and one day of reinforcement and planning for the implementation of individual SAPs. (CDC, 1992)
School Crisis Response Team. The Edina, Minnesota, school crisis response team has identified three levels of "at-risk" students with specific procedures to be followed at each level. Level three is the "suspected suicidal person." The suspected suicidal person is defined as: "the individual [who] provides a self-report of suicidal thoughts or others express concern for the person." (Peterson, Andress, Schroeder, Swanson, Ziff, & Dolan, 1993) The first step of the procedure to be followed when a suspected suicidal person has been identified is to "provide an opportunity to talk privately in a safe place." Another member of the crisis team is to be contacted. Members should communicate hope and optimism as well as offer emotional support to the individual. The parent or other person designated to be contacted in case of emergency must be notified.
Level two is identified as the "at-risk person." In the at-risk person "actual evidence exists of intended suicide by the person." (Peterson et al., 1993) Peterson, et al., outline the procedure to be followed when such evidence has been identified as:Whomever received information about a student . . . with suicidal thoughts immediately contacts a member of the Crisis Prevention/Intervention Team. That member meets and stays with the student . . . while summoning another member of the Intervention Team, who assists with the intervention. Steps taken in the intervention process include: (1) listening to what the student . . . says, taking them seriously and avoiding panic, (2) assessing risk factors, and (3) making parent contact. . . . A referral to Child Protection Services also may be appropriate.
Careful documentation of the intervention process is required at all three levels. This documentation must include information about parental contact and the parents' plans for follow-up. All intervention documentation is kept in a central file at the district office. Thus, it is possible to note previous incidents, when an intervention occurs.
Level one is the "imminent life threatened person." The imminent life-threatened person is defined as: "a person [who] has the means to commit suicide or is already hurt and has placed himself/herself in an imminent life-threatening situation." The first thing to do is to "immediately call 911 and follow their instructions." (Peterson et al., 1993) Another member of the team must be contacted. Parental contact and permission are always to be sought, but should not delay efforts to attain immediate emergency care for the student. It is the responsibility of the school to inform the parents of their concern for suicidal risk. It is the responsibility of the parents to act on that information.
The Edina Schools system recognizes the need for integrating their program into the community. They operate as a team not only to support the student, but to support and to consult with each other in a crisis. The crisis team works with local law enforcement agencies, family members, and local religious organizations to provide education. Religious leaders are notified when a crisis has occurred, who can then offer support in their own settings. Peterson, et al., conclude their article with the following:Much needs to be done in recognizing and understanding depression and responding to crises within schools. The need to maintain a support network . . . is a priority. The support circle needs to increase. Collaborative efforts with parents and community are essential links. Together, all can foster a nurturing environment sensitive and responsive to individuals in stressful and challenging circumstances.
Community Gatekeeper Programs. Community gatekeeper programs provide training to community members. "The goal of these programs is to train community members to identify young people at risk of suicidal behaviors and to refer them to appropriate sources of help." (CDC, 1992) Gatekeepers can be anyone who has significant contact with youth. They can be coaches, clergy, police officers, health care professionals, hairdressers, or bartenders. The idea behind this kind of training is that suicidal individuals may come into contact with these community members or others who do not recognize the risk. If members of the community are trained to recognize these risks, they may be able to arrange for appropriate help.
Crisis Centers and Hotlines. Crisis centers and hotlines provide emergency counseling for suicidal people. They offer referral to traditional mental health services. The function of these services hinges on the presumption that suicide attempts are often impulsive and contemplated with ambivalence. Hotlines are designed to deter the caller from self-destructive behaviors until the immediate crisis has passed. The anonymity afforded by hotline calls allows the caller to feel secure and in control. Many hotlines are linked to schools and to mental health services.
School is the center of an adolescent's life and they possess, in part, the ability to shape the students' personal and social development. Therefore, it is appropriate that the first line of suicide prevention strategies should lie within the educational system. "From the perspective of health promotion, schools are in a unique position to identify suicide vulnerable youth. This conviction fostered the development of numerous school-based prevention programs." (Thompson et al.,1994) Generally, school-based and community programs have been designed to increase awareness of signs and symptoms and to increase help-seeking. Since very few prevention programs have been systematically evaluated, there are no reliable statistics to support the effectiveness of such programs.
"The results of one study indicated that hotlines may reduce the rate of suicide among young women." (CDC, 1992) However, hotlines tend to be used by those at relatively low risk of suicide, mostly young women. Their effectiveness on the rates of suicides among men has not been demonstrated. "The effectiveness of hotlines and crisis centers . . . might be improved by increasing outreach to young males, requiring consistent training of volunteer staff, and taking steps to improve follow-through with callers." (CDC, 1992)