Protocols for the prevention of suicide in adolescents: what they are and how they work

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According to the UNICEF report ‘In my mind. Promote, protect, and care for mental health in childhood’, suicide is the fifth leading cause of death in the world among adolescents between the ages of 10 and 19 years of age. In Spain, and according to the Suicide Observatory in Spain, suicide is, after tumors, the main cause of death among Spanish youth between 15 and 29 years of age. With these data on the table, and taking into account the impact that the pandemic has had on the mental health of society as a whole and of students in particular, educational centers can be a key player in trying to prevent and avoid this problem among students. For this, it is necessary to know and activate the protocols for the prevention of suicide.

The role of protocols for suicide prevention in education

In educational centers, this type of protocol works as an information tool for all teaching staff regarding a serious problem that can occur both in childhood and in adolescence. They are guidelines that already work in some autonomous communities such as Aragon, the Balearic Islands, the Valencian Community or Galicia, and act as a guide for teachers to know the different guidelines for action if a student is in this situation. They also promote protection mechanisms against students and facilitate different preventive actions within the educational community. In other words, they try to provide all the information necessary to act quickly and effectively in the event of a possible suicide attempt by a student.

Thus, and to easily understand what type of information they offer, we look, for example, at the case of Aragón, one of the most recent. The document is divided into different sections in which both teachers and educational staff can delve into this problem knowing some of the concepts associated with suicide, such as ‘suicide risk’ (real possibility of doing so), ‘suicidal ideation’ (related thoughts), ‘attempted suicide (unsuccessful act)’, ‘completed suicide’ or ‘non-suicidal self-harm’ (self-harm without suicidal intent). These terms are accompanied by a series of myths about suicide such as that it cannot be prevented, that minors do not commit suicide or that talking about this subject can increase the risk, among others. All of them dismantled with conflicting arguments. In this way, and in terms of their usefulness in the classroom, Miguel Guerrero, psychologist and head of the Intensive Suicidal Behavior Prevention and Intervention Unit (UPII) Cicerón of the Andalusian Health Service, considers that these protocols contribute to explicitly recognizing the magnitude and importance of suicide in classrooms. “In addition, it is a very useful tool since it allows us to know at all times how we should act, what we have to do and, above all, what we should not do in a situation of this type,” he points out.

How to detect, prevent and act

The main part of these protocols focuses on detection, prevention and action. In the case of the Aragón protocol, and in the detection section, a series of risk factors (personal, family, school and social environment) and verbal warning signs are established, such as feelings of desperation, comments related to death or direct expressions about the desire to kill oneself, among others, and non-verbal ones such as changes in behavior, carelessness in personal appearance or difficulties in concentration, attention… that can help the teacher to identify if a student is experiencing for a risk situation. Guerrero agrees with the signs exposed and affirms that the most evident is “when the student explains his thoughts, ideas or suicidal intentions”. Although he also highlights others: he is withdrawn, sad or excessively anxious, isolated, refuses to go to school, abandons his responsibilities and suddenly drops his academic performance or aggressive, impulsive or excessive hostility behavior is perceived on his part. To do this, he adds that it is important “to be prepared and educated to be able to have a conversation with a student who is suffering desperately.” Secondly, and in the prevention section, the importance of the family, personal factor and the social and school environment is put on the table through a series of strategies that prevent the problem. In this way, acquiring socio-emotional skills, having attachment and reference relationships within the family environment or building positive relationships with teachers are some of the examples offered in the protocol launched in Aragon. Likewise, in the educational field it is considered relevant to give importance to emotional education, inclusive education or educational programs that strengthen the relationship between the student and the teacher.

Suicide Prevention Protocol

Thirdly, suicide prevention protocols establish guidelines and action strategies that, in the case of the Aragonese document, are divided into two main questions: ‘what not to do?’ and what to do?’ in case of suicide. The first section shows some actions that should not be carried out, such as not taking the student’s threats or information seriously, hiding information from the family or not trying to discuss or criticize the student. The second section establishes the immediate actions (depending on whether there is an imminent risk or not), in addition to proposing a series of actions in the center itself, such as protecting the minor by preventing him from being alone or the possibility of finding resources in class and telephone helplines, among other issues. With all this information, what are the first and most immediate actions that a teacher should carry out when identifying a possible case of attempted suicide in the classroom? For the psychologist Guerrero, three steps are essential: “First you have to approach the person and offer him a space of security and respect in which he can express his pain and the emotions that are making him suffer. Then you have to explore the student’s family support network, encouraging him to ask for help and express his situation to his parents, siblings, friends… And, thirdly, it is essential to connect the student with the school and health mental health network to enable specialized support, follow-up or intervention, if necessary, as soon as possible”.

Help understand what is happening

In short, these protocols help the educational staff to know and understand all the nuances of the situation that the student is going through. Something that can help, and a lot, to young people who need it.

Protocol for the prevention of suicide in adolescents

Likewise, and in addition to making use of this tool when necessary, it is also essential to talk to all students about suicide. “We must not deny this reality in the classroom. We must speak normalizing mental health, the importance of socio-emotional education and skills to resolve conflicts. Speaking openly does not increase the risk of suicide, but on the contrary, it allows creating a healthy climate in the classrooms where emotional discomfort can be expressed without fear or rejection”, says Guerrero. Silvia Melero, journalist and creator of the Mourning in Colors project, facilitator of workshops on mourning and death and the space ‘Connect to Life!’, also agrees on the need to talk about it: “Classrooms are a reflection of what what happens outside, in families, in society, in the world we build. The simple fact of opening spaces in the classroom to name, speak, make visible, build bridges, paths, listen, support tools… is already a lot. We adults have taboos, and we pass them on to the next generations. We are asking adolescents to speak up, not to keep quiet about their emotions and problems, to ask for help… If they find adults on the other side who have done that internal work, building those bridges is more fluid because there are fewer barriers.”

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