Montana has a suicide problem. The state is regularly at or near the top of the list for most suicides per capita in the United States. This coupled with an overall increase in self-harm and suicide attempts since 2008 has led schools and community organizations to be more involved in suicide prevention efforts.
One method is to reach out to youths earlier and more often with education about suicide, depression and self-harm. The Signs of Suicide training program for middle and high school students can help youngsters recognize when they or a friend are in need of help. This program is taught in the first few months of the year.
The program is taught in middle and high schools in the greater Helena area, with high school students also receiving additional Youth Aware of Mental Health training. The two-part program consists of an education portion and a mental health screening. Parents can opt out of both, but counselors reported that parent skepticism has dropped significantly since it was implemented three years ago.
The program was implemented with help from the Montana Department of Public Health and Human Services by mandate from each district’s school board. Each school can choose how to implement the program, with one required portion being to show a video provided by DPHHS.
Helena Middle School and East Valley Middle School both implemented the program as part of their health training. Kevin Flatow, Helena Middle School counselor, said it was the best way to reach every student in the school.
CR Anderson Middle School implements the program as part of its social studies class. Mary Anderson, school counselor at CR Anderson, said nearly every student takes social studies and the ones who do not will be taking a study skills class, which they can be pulled from in order to receive their SOS training.
Anthony Hogan, physical education teacher at Helena Middle School, said the overall goal of the program is to teach kids via the ACT method: Acknowledge the signs of suicide or depression, Care about that person and their well-being, and Tell a trusted adult who can help that student.
They also teach students risk factors such as recent life events that might trigger depression in a peer and safety factors such as the network of support surrounding that peer.
Additionally, in each school the program evolves from sixth to eighth grade alongside the emotional maturity of the students. “Developmentally, the older students can handle more emotionally,” Flatow said. Helena Middle School Principal Cal Boyle said this can vary from student to student, which is part of why they start the training young.
The middle school teachers and counselors implementing the program strongly believe it’s having a positive impact on the students. Counselors from Helena Middle School, East Valley Middle School and CR Anderson Middle School all found that reports of students in need increase during the time period the training takes place each year. Many use an anonymous note system that helps encourage students to report friends they think may be in need.
Kevin VanNice, vice principal and former counselor at East Valley Middle School, said he already had his eye on many of the students identified. “But I’ve also gotten a lot of names that weren’t on my list. Kids who don’t speak up much,” VanNice said.
Flatow said he has been incredibly impressed with how students have responded to the training and reported concerning behavior to adults. “It helps us adults do what we are meant to do, which is to wrap support around students,” he said.
Hogan said he hasn’t seen much apprehension from students in the three years he has implemented SOS. Instead, he reported that students are typically very engaged during the lesson and aware of their options moving forward. Hogan believes the training helps dispel the myth that only experts can help prevent suicide by showing ways that everyone can help.
Anderson has also seen little apprehension. She reported, like the other counselors, that most students who opt out are ones that have recently been impacted by suicide or otherwise are sensitive to the subject. One thing she teaches students is the school wants them to be trained to help their friends, while also educating them that they are not the only ones who can help.
“They need more help than you can give them, and the best thing you can do is to get them with someone who can help,” Anderson said. “It’s important for these kids to know it’s not their fault if something happens to their friend.”
The counselors all reported a similar pattern of parent skepticism over the years. During the first year of the training parents were very apprehensive, but this has calmed over the past three years. VanNice and Anderson both said most who opt out have special circumstances. VanNice said the opt-out method has resulted in higher participation rates among students than an opt-in method might.
Parents previously against the training believed middle school students might be too young to discuss topics surrounding suicide, or that it might have a negative impact on their own mental health, reported the counselors. Psychiatric registered nurse Abbie Colussi, adjunct faculty at Carroll College and Lewis and Clark County Suicide Prevention Coalition board member, said these kinds of fears are a “very common myth.”
“On the contrary, it offers hope and gives students an opportunity to talk and ask for help,” Colussi said. “Not only has SOS been shown to reduce suicide attempts, but more importantly it increases help-seeking behavior by other kids.”
She continued by stating that the training increases the knowledge youths have about depression and suicide. This is good because youth recognize the signs in their peers much quicker than adults do, according to Colussi. Anderson said that in cases of completed teen suicide, peers often knew about something that had happened in the previous 24 hours that adults were unaware of.
Anderson believes parents are quickly becoming more aware of what their students are exposed to, including social media. She polled her students and found that nearly 80 percent of those who have access to social media have seen a Snapchat in which someone said they wanted to die. Many of the students in her classes have in the past asked their parents to help a friend who was emotionally distressed. Anderson credits greater parent acceptance and less apprehension about this kind of training to factors like these.
The SOS program dates back to the early 2000s and has long been on the Substance Abuse and Mental Health Services Administration’s national registry of evidence-based programs and practices. The administration based that qualification by reviewing several independent studies, dating back to 2001, which found the program reduced participants' likelihood of attempted suicide by approximately 40 percent compared to students without the training.
Additionally, these studies found that participants demonstrated greater knowledge about depression and suicide, had more desirable attitudes towards the subjects and a greater awareness of their peers. Dr. Robert H. Aseltine Jr. concluded the program was “the first school-based suicide prevention program to demonstrate significant reductions in self-reported suicide attempts” in a 2004 report to the American Journal of Public Health.
A 2017 report by Dr. Melissa Mercado, published in the Journal of the American Medical Association, showed a significant increase in self-harm and attempted suicide by youths aged 10-14 since 2008 based on emergency department visits over 15 years.
Boyle believes SOS training is just one small piece of a larger conversation that takes place surrounding mental health. “It needs to be a community intervention,” he said. “But we will play our part as well.”
Anderson said she admires the commitment from the school district to caring for the mental health of its students. “Our communities and our schools have been hurt by suicide,” she said. “As a community we are dedicated to helping our kids, and doing anything we can to help them.”