04.08.14

In the Aftermath of Suicide: Helping Communities Heal   by Mary Glenn

http://fulleryouthinstitute.org/articles/in-the-aftermath-of-suicide

“Student committed suicide, please call ASAP”.

The text flashed across my phone while I was sitting in my Tuesday night Bible study. It’s the kind of text I have received countless times before, and it’s never easy to read. A 14-year-old boy killed himself after school. As the local senior police chaplain, I was called in to provide support, grief care, and help to school personnel who were dealing with this trauma.

When I arrived at the school the next morning, I was asked to meet in the vice-principal’s office with the student’s teachers and guidance counselors. These staff members were in shock, wrestling with grief and guilt. They asked the “What if” questions; What if I missed something? What if I could have stopped him from doing this? What if I would have known the pain he was in?

One of the student’s teachers stated, “There is nothing you can say that will convince me that it isn’t my fault. I missed the signs. I could have stopped it.” What someone feels in that moment is real—as real as it can get. I can’t talk someone out of feeling guilt, but what I can do is listen with care, offer compassion, and help people understand some of the dynamics of suicide.

As youth leaders, mentors, and those invested in young people, suicide rates should concern us. Why are so many kids killing themselves, and how can we begin to understand the complexities of this issue? When kids commit suicide, the community is left with questions, grief, and anger. What can we do to help communities heal from this trauma?

Suicide Rates Remain Too High

Young people are killing themselves at alarming rates. For ages 10-24, suicide is the third leading cause of death. 1  In fact, “More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease, combined!” 2

We need to be concerned not just about completed suicides, but also about suicide attempts. Teens attempt suicide more often than complete it. A nationwide survey of youth in grades 9–12 in public and private schools found that “16% of students reported seriously considering suicide, 13% reported creating a plan, and 8% reporting trying to take their own life in the 12 months preceding the survey. Each year, approximately 157,000 youth between the ages of 10 and 24 receive medical care for self-inflicted injuries at Emergency Departments across the U.S.” 3 All teens are at risk, but boys are the most likely to die from suicide attempts. While girls are more likely to report attempting suicide, 80% of suicide deaths are boys. 4 Culture also plays a role in who attempts and completes suicides. Among our most at-risk teens are Native American/Alaskan Native youth (who have the highest rate of suicide-related fatalities) and Latino youth (who are more likely to report attempting suicide than their non-Latino peers). 4

Why Are So Many Kids Killing Themselves?

We will never know exactly why a student took their life, but there are ways to recognize and identify if a teen may be in trouble. Potential teen suicide risk factors include: 4

  • access to lethal methods
  • depression/mental illness
  • divorce/family changes
  • drug/alcohol abuse, alcoholism in the home
  • exposure to domestic violence
  • family history of suicide
  • feeling that their life doesn’t matter, lack of self-worth/value
  • feeling that people don’t know/care for them
  • history of previous suicide attempts
  • identity issues
  • incarceration
  • lack of community/isolation
  • loss/grief
  • moving to a new/different community
  • physical, sexual abuse or emotional neglect
  • stressful event
  • victim of bullying

The top three methods used in the suicides of young people include firearms (45%), suffocation (40%), and poisoning (8%). 7  I have found this to be true in my own experience, as the majority of youth suicide cases I’ve responded to involved a firearm, usually belonging to a parent.

Several factors can put a young person at risk for suicide. However, having these risk factors does not always mean that suicide will occur. One of the most significant risk factors for teen suicide is depression. As the Los Angeles Department of Mental Health states, “It is estimated that depression increases the risk of a first suicide attempt by at least 14-fold. Over half of all kids who suffer from depression will eventually attempt suicide at least once.” 8 Further, fifty-three percent of young suicide deaths involve substance abuse.

One study revealed that teens under 18 who lost a parent to suicide were three times more likely to commit suicide than children and teens with parents living. 9  After the 2008 economic downturn, several parents in my community took their own lives due to the financial stress they were facing. I have responded to teen suicides where the young persons’ death was preceded by one of their parents taking their own life. When a teen loses a parent, their vulnerability increases greatly.

Finally, untreated and undiagnosed trauma contributes to feelings of hopelessness that can lead to suicidal actions. Teens are being exposed to trauma at concerning rates. Movies, video games, TV shows, and violent life experiences imprint images on the brains of young people. Our eyes and minds process and record trauma (what we have seen and experienced) in our memory. As a result of this trauma, teens can struggle with flashbacks and disturbing memories and emotions, which if left undiagnosed and untreated, may result in teen suicide.

Suicide Is A Complex Reality

After a suicide, we may find ourselves asking many “why” questions: Why did this happen? Why couldn’t I stop it? Why didn’t I see the signs? We are looking for explanations. Sometimes it’s helpful to keep reminding one another that suicide is one person’s decision. We may feel responsible and blame ourselves, and at the same time be angry that this teenager didn’t even give us a chance to help them. Anger is part of the grief process and a normal reaction to teen suicide. We may be plagued with a complex mixture of emotions such as guilt, anger and lack of closure. All are valid and real.

In the majority of attempted suicide attempts, there were signs. 10  However, it is almost impossible to discern unless you are the person contemplating committing suicide. People mask their emotions. The “What if?” questions won’t bring the person back. Replaying of the last conversations and interactions we had with the student won’t change the reality. One person’s suffering, sadness, and decisions have repercussions that reach deeply into the community.

The Deep And Ongoing Impact Of Suicide

I was a youth pastor for 15 years and have served as a police chaplain for almost 15 years. My first police chaplain call was to give a death notification to the family of an 18-year-old (the only son in the family) who committed suicide. The parents were confused, sad, and devastated. Their lives were turned upside down on hearing the news.

Suicide can also expose us to trauma as those who help in the aftermath. Trauma is a result of exposure to a critical incident or distressing experience and, if left untreated, it can result in PTSD (Post Traumatic Stress Disorder) or other issues. We can’t control when tragedy happens, but we can help lessen the impact. This is called trauma care. As those who work with young people, we need to care for ourselves so that we can help offer care to others. This may mean finding a safe place to process our own traumatic stress from being part of the situation.

We all grieve differently. It is important that we give ourselves and each other space and time to grieve. Grieving collectively (e.g., funerals) plays a key role. Together we can remember our lost loved one. Sometimes one death can bring up previous loss and grief. While I was talking with one of the teachers of the 14-year-old who committed suicide, she was filled with grief not just from the recent student suicide but also from an accidental student death ten months previous. Both of the students were in her class. She was feeling the loss of the first student as she was processing the reality of the second student’s death.

Best Practices For Healing

The loss of suicide brings permanent changes. In the aftermath of death, we enter into what is sometimes called the “new normal.” We long to return to the days of old, before this loss. The reality is, we can’t. We must step into the new normal and find ways to deal with the loss. Grief is an important part of this process, and it is imperative that we grieve well. 11 In the article “A New Normal: Ten Things I’ve Learned about Trauma”, Catherine Woodiwiss offers several best practices in dealing with trauma and grief, including: 12

  1. Be present with people
  2. Healing takes time
  3. Grieving and healing are both social experiences
  4. Don’t offer cliches or comparison
  5. Allow people to tell their own stories

Recovering from teen suicide certainly takes time. But we are not guaranteed that we will be stronger after this, or that we will find full healing. Be careful not to make promises to yourself or anyone else that this will be the case.

Below are some additional guidelines that will help us find healing for ourselves as well as those around us who are struggling with the grief following teen suicide:

  1. Ministry of presence. We can embody the peace and presence of God by being present with others, sitting with people in the midst of their pain. During our own grief we need not isolate ourselves, but rather invite community to journey with us.
  2. It’s not okay, but it won’t always be this way. Clichés we use on ourselves and with others can bring more pain. The fact that this student was in pain and took their own life changes us all forever. Yet things won’t always be this way. Eventually we can begin to rebuild life after loss.
  3. Face down the guilt, shame, and anger. We may feel like we could have done something. Going down that road won’t bring them back. The teen we loved made a decision and took their own life. They are gone and we can’t change that. But the emotions we feel are real, and we need to create healthy space for feelings to be expressed.
  4. We can’t change the fact that a teen took their life, but we can lessen the impact of the death on our community. Participating in group processes like CISM (Critical Incident Stress Management) debriefs can mediate the impact because they offer opportunities to talk through the loss with others. CISM is a process by which we discuss what happened, what we saw, felt, experienced, etc. in a group setting with others who are going through this with us. This isn’t equivalent to professional therapy, but is a way to lessen the intensity of the loss by giving a safe space in a group guided by a facilitator. Professional therapy, pastoral counseling, and grief counseling can also assist in community healing. Be sure to be prepared with referrals of local helpers for young people and their families.
  5. Acknowledge the impact of the death imprint. When we see or experience something traumatic, our brain takes a picture of what we see or what we can imagine. That death imprint stays with us. Smells, sights, and sounds might cause the memory and pain from that event to be recalled. Be patient and sensitive with yourself and with others when this happens.
  6. God is with us. In the midst of the loss and pain, we must remember that God is always with us. In Psalm 32:7 we are reminded that God keeps and surrounds us: “You are my hiding place; You shall preserve me from trouble; You shall surround me with songs of deliverance.”   Feeling alone with our grief can overwhelming. But we are promised that God is with us. 13
  7. Cling to hope! Even when we don’t feel it, hope is there. In the midst of losing our loved one, hope helps us to see what is ahead and to look to the future rather than being stuck in the present and past.

Action Steps

  1. Assess your own grief process and management in dealing with loss and death. What are your best self-care practices?
  2. Read an article or book on loss and grief. Discuss it with your small group or in community with other leaders. How does your ministry handle loss and death well? What could you put in place to respond better?
  3. Begin building (or revisit and strengthen) a database of local caregivers who can help after tragedies like suicide or other deaths.
  4. Learn more about suicide prevention and warning signs. Part 2 of this article will provide more tips for prevention.

Part 2:

I was asleep when the phone rang. It was about 11:30 p.m. One of my students was on the line.

“Hi Mary, I just wanted to say thank you for all you have done for me. And I wanted to say goodbye.”

By the time I responded, he had already hung up. This student had expressed sadness over a recent breakup. I knew he was depressed, and I believed he had access to a gun. I quickly realized that this was not a routine phone call. This was his goodbye call to me. I had to react now!

But what do I do? I immediately called one of my volunteer leaders to call the student back and find out where he was. Then I called the police. This situation needed an immediate response.

Thankfully, the student survived. He is now a healthy, joyful adult with a family. But this was a pivotal moment in his life.

In part 1 of this series on teen suicide (In the Aftermath of Suicide: Helping Communities Heal), we talked about the realities of suicide and what we can do when our own schools, neighborhoods, or churches encounter it first-hand. In part 2, we will explore how can we turn suicide response into prevention. What can we do to stop teen suicides before they happen?

Indicators and Signs to Look Out For

As someone who loves teenagers, you can increase your awareness of teens who might be struggling with depression and contemplating suicide. Here are some of the indicators to watch for:

  • Changes in behavior (i.e. school performance)
  • Increased use of alcohol or drugs
  • A victim of bullying
  • Social isolation or social withdrawal
  • Showing signs of depression including loss of pleasure, frequent sad mood, changes in sleeping or eating patterns, feelings of hopelessness, irritability, feelings of failure or shame
  • Giving away prized possessions
  • Threatening suicide, expressing suicidal feelings directly, or bringing up the topic of suicide
  • Developed a plan for suicide

In response to indicators like these, here are some things we can do to help:

  • Remain calm
  • Engage them in conversation
  • Ask them if they are contemplating suicide
  • Listen and be present
  • Remind them of your care and love for them
  • Accept their feelings
  • Be compassionate and understanding
  • Reassure them that there is help
  • Do not judge
  • Develop a plan for help

Ask them if they have thought of a plan for suicide. If so, don’t leave them alone. Remove any means for self-harm, and contact necessary parties (parents, police). 1

Most importantly, if a young person asks you to keep a secret about their contemplating suicide, that is a secret you can neither make nor keep. You can say, “I want you to know you can trust me, but I need you to know that I can’t keep what you just shared a secret. I’m going to walk with you through this process of telling your parents. You will not be alone in this.”

Remember, no one should handle this situation alone. Building partnerships with parents, mental health professionals and school staff in your community will be key. In fact, part of prevention is building ongoing relationships with these community partners such that when a tense situation arises, you know who to call (and so do they) for additional support.

Be a Voice of Hope

In any community, teens can feel lost, overwhelmed, hurt, confused, alone, and disconnected. All young people have needs for attachment, affirmation, and a sense that their lives matter. These needs quickly become thrust to the surface when they aren’t being met and when adolescent emotions run high. Jeremiah 17:9-10 in The Message translation reads, “The heart is hopelessly dark and deceitful, a puzzle that no one can figure out. But I, God, search the heart and examine the mind. I get to the heart of the human. I get to the root of things. I treat them as they really are, not as they pretend to be.” God perceives things as they really are. When teens face disappointment and rejection, these feelings may deceive them into believing things are worse than they really are and may convince them that there is no hope. Suicide becomes a permanent solution to a temporary problem.

Teenagers may feel trapped in their circumstances. They want to stop the pain. Sometimes the first thing we can do—and perhaps the most consistent support we can offer—is to give young people an anchor of hope.

Without jumping too quickly to platitudes, verses like Hebrews 6:19 can be helpful as we counsel and pray with young people: “We have this hope as an anchor for the soul, firm and secure.” An anchor is what keeps a ship grounded, connected, and steady in the midst of storms. We may similarly find ourselves drifting in life or in our emotions, but hope, the anchor of our souls, reminds us of who we are and whose we are. Hebrews 10:23 follows, “Let us hold unswervingly to the hope we profess, for he who promised is faithful”. Jesus has better things ahead. He has purpose for our students’ lives. Our perception of hope can change based on our feelings and emotions, and for some young people, the fight can be overwhelming and paralyzing.

As youth workers, mentors, and family members who care about teenagers, we can be a voice of hope. Speaking hope and future into students’ lives is a first step in helping them work through pain. What isn’t helpful is minimizing their pain or promising them that everything will be okay. From my training in intervention and suicide prevention, here are a few examples of what to say in a situation like this:

  • “I am so sorry that you are going through this. I am here with you now; you are not alone. Together we will find you the help you need.”
  • “Right now it may feel like there is no way out, but the way you are feeling will change.”
  • “I may not know exactly what you are feeling, but I care about you and I want to help.”

From Suicide Completion to Suicide Prevention

In the aftermath of actual teen suicide, friends and classmates can be left confused and sad. There are ways we can help our students work through their feelings and emotions, even potential thoughts they may have about suicide, including:

  • Acknowledging what happened
  • Asking about their feelings
  • Honestly answering questions about suicide
  • Asking the young person if they are thinking about suicide
  • Reminding them to talk to adults if they have concerns (and you can help them come up with a list of people to talk to). 2
  • Remembering the student who committed suicide, celebrating their life, and remembering it annually (i.e. planting a tree in their memory, sharing stories about them).

A few years ago I responded as the police chaplain to the suicide of a popular, beloved 16-year-old student. He was involved in sports and service clubs, and was loved by both students and teachers. I led debriefs for teachers, students, friends, and family. His funeral drew the attention of the community with almost 1,000 in attendance at his memorial service. As chaplains responding to the crisis, we worked in partnership with school staff, parents, crisis counselors, and others.

People from across the community came to try to make sense of this tragedy. Why would this student, who seemed to have it all, take his own life? His memorial service was conducted by three police chaplains; his death provided an opportunity for us to educate people about suicide prevention.

During the memorial service, we spoke from John 12:24, “Very truly, I tell you, unless a grain of wheat falls into the earth and dies, it remains just a single grain; but if it dies, it bears much fruit.”  We handed out stalks of wheat and encouraged the students to live their lives to the fullest. The memory of their friend now lives in them. We encouraged them to tell others that they care for them and reach out to those who may feel hopeless. When the seed dies, hope, life, and purpose can result.

Grieving and remembering together is an important step in the healing process. Life can come from loss, and death and pain can be redeemed. Together we can work to prevent teen suicide.

Action Steps

  1. Develop partnerships in your community with mental health professionals, school staff, and parents. Working in collaboration with all of your partners in the community requires that there is ongoing communication before the crisis and that everyone knows the role they play in students’ lives. Of course there can be overlap in care, but we want to make sure that all the people in a student’s life will cover the needs the student has.
  2. Observe if there are there any indicators that any of your students may be at risk (see the list in the first section). What kind of action steps will you take?
  3. Mentor a student. Play a proactive role in a young person’s life. Work to find other mentors in your community for those young people who seem most at-risk for suicide or other threats.

Additional Resources

American Foundation for Suicide Prevention www.afsp.org

Los Angeles County Youth Suicide Prevention project http://preventsuicide.lacoe.edu/

National Suicide Prevention Lifeline www.suicidepreventionlifeline.org

Suicide Prevention Resource Center www.sprc.org

American Academy of Child and Adolescent Psychiatry (AACAP) www.aacap.org

American Association of Suicidology (AAS) www.suicidology.org

Glover, Beryl S. and Glenda Stansbury. The Empty Chair: The Journey of Grief After Suicide.

Hsu, Albert Y. Grieving a Suicide: A Loved One’s Search for Comfort, Answers, and Hope.

Lewis, C.S. A Grief Observed. 

National Alliance for the Mentally Ill (NAMI)  www.nami.org 

National Mental Health Association (NMHA) www.nmha.org 

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