School-Based Suicide Prevention: Research Advances and Practice Implications
Berman, Alan L., School Psychology Review
The problem of adolescent suicide has vexed and perplexed social scientists for more than a century. Meeting in his living room in 1910, Sigmund Freud chaired a discussion among a distinguished panel of interdisciplinary scholars from the Vienna Psychoanalytic Society in an attempt to understand and propose solutions to an observed and alarming increase in suicides among young students (Friedman, 1967; Berman, Jobes, & Silverman, 2006). In the United States, rates of youth suicide dramatically increased between the mid-1950s and the mid-1990s, and since have declined by about a third. We have dozens of hypotheses to explain temporal shifts in the epidemiology of youth suicide, but little in the way of evidence-based findings to inform evidence-based prevention programs that would allow us to gain some degree of control over these phenomena.
This said, the science of suicidology has grown considerably over the last half century. The mere extent of research attention, no less the relative sophistication of recent efforts to better understand, control, and predict youth suicides, offers greater insight and information than ever before and presents significant hope for the future. This special issue of School Psychology Review serves to further these goals by focusing our attention on five important papers intended and designed to help us better accomplish this work.
Why should we be focused on the prevention of suicide and suicidal behaviors among students in our schools when it might be, and has been, reasonably argued that the youth at greatest risk are those who are least likely to still be in school. Indeed, adolescents with risk for dropping out or being expelled (Randell, Eggert, & Pike, 2001), youth in juvenile detention facilities (cf. http://www.chdi.org/publications.php?category=juvenile-justice), runaway and homeless youth (U.S. Public Health Service, 2001), and those already placed in alternative schools (cf. http://opi.mt.gov/pdf/yrbs/Altreport.pdf) have greater risk for suicide than those in mainstream schools.
The reason we do is framed by the adage "get them where they are at." Guided by Rose's theorem (1992), which states that "a large number of people at small risk may give rise to more cases of disease than a small number who are at high risk," school suicide prevention programs attempt, in general, to reach the greatest number of adolescents, hoping to detect the smaller number most at risk and then to identify and refer them for intervention (assessment and possible treatment) before they become acutely suicidal.
Moreover, a recent survey of members of the National Association of School Psychologists conducted by the American Association of Suicidology (American Association of Suicidology, 2008) found that 86% of school psychologists reported that they had counseled a student who had threatened or attempted suicide, 35% reported that a student in their school had died by suicide (and nearly one-half of these had more than one), and that almost two-thirds (62%) reported that they knew a student at their school who had made a nonfatal attempt.
Thus, the need for greater understanding of and a developed knowledge competency regarding adolescent suicide and school suicide prevention is well defined by the prevalence of suicidal behavior among even ostensibly well-functioning youngsters in mainstream schools. The need is further cemented by another finding reported by the American Association of Suicidology. Of those school psychologists surveyed, only 22% believed their graduate training had sufficiently prepared them to adequately intervene with suicidal youth or to contribute to school post-intervention activities were there to be a death of a student by suicide.
David Miller and Tanya Eckert's (2009) introduction to this special series makes brief mention of yet another reason why this effort is so important for school psychologists (i.e., they have an ethical and legal obligation to make reasonable and prudent efforts to prevent youth suicide where possible). …