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My professional perspective is that of a high school counselor. I am beginning my 7th year teaching high school math, and will be receiving my Master's in Guidance and Counseling in December of 2019, after which I will hopefully begin working as a high school counselor for the next school year. This legal guide padlet is a resource for counselors as well as other faculty to understand the protocol, warning signs, and severity of suicide and best practices when working with Suicidal students. As a teacher, I do not feel that I was properly trained on how to work with suicidal students as well as warning signs to look for. I also did not know what the school policy was for suicide prevention prior to creating this padlet. Hopefully this padlet will be a tool that counselors, administrators, teachers, and other faculty can use to feel more confident when working with students who might be at risk of committing suicide.

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I spoke with the Lead Counselor at Azle High School, Heather Huffaker about the policies and procedures for suicide prevention.
How does suicide impact your field of education?
It is my duty to be aware of students who are displaying signs of suicide and implement the policies and procedures put in place by the district and state to prevent suicides. It is a critical part of my job to help students who are at risk of suicide.
What are some best practices for preventing suicide?
The most important practice when working with students at risk of suicide is to contact the student's parents/guardians. A parent/guardian should always be contacted if a student is at risk of suicide, no matter how low the risk is. Azle ISD uses the Columbia-Suicide Severity Rating Scale to determine the level of risk a student is experiencing. The levels (low, moderate, high) should be taken seriously and should never be downplayed. If a student is at moderate to high risk, the parents are encouraged to pick up their students from school and meet with the counselors to decide an intervention plan for the student. If the parent cannot pick up their student, then the police should transport the student to the emergency room. A student at risk should never be left alone.
What is an emerging issue that should be watched that could impact your work?
The American School Counseling Association has recently decided that using risk assessments such as the Columbia-Suicide Severity Rating Scale should not be used as a best practice for assisting students at risk of suicide. The association claims that students could be lying about their level of risk of suicide and that the risk assessment could cause counselors and parents to lessen their concern of the student's suicide risk. It will be interesting to see if policies and procedures by the state and districts will change due to the ASCA's lack of support for risk assessments.

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The position statement of the American School Counselor Association is focused on providing help to students who are at risk of suicide. The number of students committing suicide has risen in the past 15 years; therefore, it is imperative that counselors understand the signs of suicide risk as well as have plans in place for dealing with suicidal students, including notifying the parents. These procedures must be implemented in any case that a student is suspected of suicide risk, regardless of student denial(American School Counselor Association, 2018).

American School Counselor Association. (2018). The School Counselor and Suicide Prevention/Awareness. Retrieved from School Counselor: https://www.schoolcounselor.org/asca/media/asca/PositionStatements/PS_Suicide.pdf

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The rural mountain west is home to 8 of the 10 states with the highest suicide rates.

Mental illness mentality, lack of jobs and opportunities, and access to guns are all possible reasons why the rural mountain west has such high suicide rates.

Grand Junction ISD decided to implement the evidence based suicide prevention program, Sources of Strength, to combat the high suicide rates.

This program implements peer mentors who are trained identify students at risk of suicide and act as a liaison to provide help to students at risk of suicide.

The district also hired a full time suicide prevention coordinator to assist the students, faculty, and staff with suicide prevention.

Though it could take years to see progress, the district as well as the town of Grand Junction are hopeful that the Sources of Strength program as well as the assistance of a suicide prevention coordinator will positively affect the students and citizens of Grand Junction, Colorado (Siegler, 2018).

Siegler, K. (2018, October 23). How One Colorado Town Is Tackling Suicide Prevention — Starting With The Kids. Retrieved from NPR: https://www.npr.org/sections/health-shots/2018/10/23/658834805/how-one-colorado-town-is-tackling-suicide-prevention-starting-with-the-kids

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At the confluence of the Gunnison and Colorado rivers, the town of Grand Junction, Colo., sits in a bowl of a valley ringed by tall mountains, desert mesas and red rock cliffs. For local residents like Victoria Mendoza, sometimes the setting makes her and others feel isolated.

"I know we can't really fix this because it's nature," says Mendoza. "I feel like people in our valley feel like there's only life inside of Grand Junction."

Mendoza, 17, has battled with depression. It runs in her family. The first funeral she ever went to as a little girl was for an uncle who died by suicide. Things got even worse during the 2016-2017 school year. There were seven teen suicides, including a student Mendoza knew from being in band together. At another high school, a student killed himself in the parking lot in front of a crowd.

"It felt like there was this cloud around our whole valley," Mendoza says. "It got to a point where we were just waiting for the next one."

Eight of the top ten states with the highest suicide rates in the nation are in the rural mountain West, including Colorado. The region has been labeled "the suicide belt." Even scenic mountain resort towns like Aspen and Durango, Colo., have reported upticks in suicide. Suicide is a problem everywhere in rural America though. More than half of those surveyed in a poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health said they knew someone personally affected by suicide.

Here in Grand Junction, the community has started to tackle their problem in a proactive way. In a movement largely driven by high school students, the community has made suicide prevention - and improved mental health - a major priority.
'Pick yourself up'
It's not clear why mountain states are hit so hard by suicides. One reason that research points to may be that suicide is stigmatized across the West, where self-reliance and a "pick yourself up by the bootstraps" mentality runs deep.

"We unfortunately think of mental illness instead of mental health," says Cathy Ebel, who has worked in the Mesa County School District for 30 years.

Historically, resources have been thin in rural areas, too. A lack of jobs and economic opportunity may contribute to suicide risk, and these communities are often short on mental health treatment options. Grand Junction does have a small mental health hospital. But it's the only one between Salt Lake City and Denver, a 500 mile span.

A third reason is access to guns. The mountain states tend to have the highest suicide rates and also the highest rates of gun ownership.

"That's not a political statement one way or another," Ebel says. "We have guns in our home because my boys hunt, but I think the accessibility makes a difference."

In Grand Junction, regardless of the causes, Ebel says that after the teen suicides during the 2016-2017 school year, the district was forced to act. The old way wasn't working.

Victoria Mendoza says, at first, kids were told not to talk about the suicides or publicly memorialize the victims. The thinking was that there would be copycats, or students might not get the proper advice if they talked to adults who weren't trained. All of this was frustrating for students like Mendoza.

"It kind of made a division between all of us because we were all scared to even say anything about it," she says.
Sources of strength
In 2017,the district adopted a suicide prevention program called Sources of Strength or SOS, an evidence-based program in schools around the country.

Mendoza, who's now a senior, is one of dozens of peer mentors in the program. She's trained to be a "gatekeeper," to recognize when fellow students could be in trouble. SOS mentors are not junior psychologists. But the idea is that someone like Mendoza might be more approachable to another kid at first. And she also may be able to recognize someone who is struggling earlier on, and connect them to help.

A lot of the change was brought on by students, who demanded action.

"We realized that we didn't really have any mentors to go to, especially if we personally were affected by the suicides," Mendoza says.

The school district hired a suicide prevention coordinator to work in the schools full time. Every employee - from teachers to bus drivers - has to have mandatory suicide prevention training every year. Students receive a similar training, beginning in the sixth grade and a mental health "resiliency" curriculum begins even earlier, in grade school.

At Orchard Mesa Middle School in Grand Junction, a group of 8th graders gathered in the lunchroom on a recent morning before classes. They taped hundreds of note cards up to the wall with handwritten messages on them: short, positive messages of what made a good friend or how a friend helped them through tough times.

Student Lily Lee says her idea of a good friend was someone who helped others feel positive, to "just support them through what they're going through so they don't feel like giving up."

Spend some time in the schools here and it's striking just how many people you meet who have been directly affected by suicide. Lee's father and uncle died by suicide.

"It's tough to share," Lee says. "But I've shared it a lot [lately] and it if it helps other people cope I don't mind."

Lee, too, is a peer mentor, acting as a role model and talking openly about why it's important to be strong and help others. At Orchard Mesa alone, the goal is to have at least 10 percent of the student body trained.
Starting upstream
What's going on in Grand Junction represents a broader shift in public health thinking. The idea is that when you tackle a seemingly insurmountable problem like suicide, you start "upstream," focusing at its earliest roots, at a time that may be years before someone gets to the point of a crisis. In this case, the strategy is to zero in on the mental health and well-being of every kid, and for that matter everyone in the entire community.

In Grand Junction schools, people on the front lines sound confident that this is going to work. Though it could take years to see real results.

One person in the community who's watching all of this is Kari Sewell. She had two daughters in high school here recently. Six years ago, she lost her husband to suicide. In fact, that is the demographic most prone to suicide - older men, like Lily Lee's father and uncle, and Sewell's husband.

"The idea of having a peer, or someone who is supporting you who has been through that experience, I think is incredibly valuable," Sewell says. "You're traumatized - you don't know which way to turn."

Sewell's husband grew up here, was captain of the Grand Junction High football team, valedictorian of his class. He was also a pilot in the Gulf War and for United Airlines. Later he was a dad and a competitive bike racer. He was a community fixture.

"Suicide has no boundaries, even in beautiful places with incredibly successful, active, healthy people," Sewell says.

After her husband passed away, Sewell wrestled with staying or moving home to Park City, Utah. But she decided to stay in Grand Junction and go back to school to study social work. She now works as a program adviser at Colorado Mesa University.

She says her town and others in the Colorado mountains have come a long way even just talking about suicide since her husband's death. "Gosh, I guess it's a double edged sword," Sewell says. "It's so common here that there are so many people in the community who are struck by it in one way or another."

While there are suicide programs in Grand Junction aimed at older age groups, the bulk and focus of most of the resources is going to the schools.

Why? Genevieve Morris, the school district's new suicide prevention coordinator, says it's because students are demanding action.

"They have the most powerful voice, research tells us, when it comes to creating social movements and changing social norms and changing the things that need to change," Morris says.

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How One Colorado Town Is Tackling Suicide Prevention - Starting With The Kids

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At the confluence of the Gunnison and Colorado rivers, the town of Grand Junction, Colo., sits in a bowl of a valley ringed by tall mountains, desert mesas and red rock cliffs. For local residents like Victoria Mendoza, sometimes the setting makes her and others feel isolated.

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Between 2006 and 2016, the suicide rate of children ages 10-17 increased by 70 percent.

The leading cause of suicide was due to untreated mental illnesses.

Family problems, bullying, academic pressure, and social media are all culprits as to why the suicide rate has increased so rapidly over the past ten years.

LGBTQ students are also highly at risk of having suicide ideations, as 40% of students who identify as LGBTQ have considered committing suicide.

States such as California have created laws requiring schools to have a suicide prevention program in place at all schools (Flannery, 2018).

Flannery, M. E. (2018, May 14). As Teen Suicide Rate Increases, States Look to Schools to Address Crisis. Retrieved from NEA Today: http://neatoday.org/2018/05/14/teen-suicide-prevention/

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In April 2018, the Centers for Disease Control (CDC) reported that the suicide rate among U.S. youth, ages 10 to 17, had increased by 70 percent between 2006 and 2016.

According to a separate study, the CDC found that among young girls, ages 15 to 19, the suicide rate doubled from 2007 to 2015, its highest point in 40 years. The suicide rate for boys increased by 30 percent over the same time period.

The numbers are staggering and profoundly disturbing - and probably a shock to most people, including those who may already be aware of the "suicide clusters" that shook schools and communities such as Palo Alto, CA.

Untreated mental health conditions are among the leading causes of suicide, and this alarming increase is more proof that young people are an increasingly vulnerable group when it comes to mental health, say experts. Teen depression rates are on the rise, yet obstacles prevent students of all age groups from getting the help they need.

Experts cite a number of reasons why teens are so susceptible. Bullying, academic pressure, family problems, and social media are all risk factors.

"Honestly, I've had more students this year hospitalized for anxiety, depression, and other mental-health issues than ever," said Kathy Reamy, school counselor at La Plata High School in southern Maryland and chair of the NEA School Counselor Caucus. "There's just so much going on in this day and age, the pressures to fit in, the pressure to achieve, the pressure of social media. And then you couple that with the fact that kids can't even feel safe in their schools-they worry genuinely about getting shot-and it all makes it so much harder to be a teenager."

Too many schools have become pressure cookers, says Denise Pope of Stanford University.

"I've spoken with many kids who tell me, 'I'm studying as hard as I can and my parents are saying I just need to study harder.' These kids stay up all night and focus 100 percent on schoolwork to get ahead," Pope says.

Many students don't want to disappoint their parents, adds Reamy. "It's so hard for the kids who are already maybe perfectionists, and they're getting the first B in their lives and they're fearful it's going to prevent them going to college, any college, never mind their dream college," she explains.

LGBTQ students face a particularly high suicide risk. In 2017, researchers analyzed the 2015 National Youth Risk Behavior Survey and found that 40 percent of high school students who identify as gay, lesbian or bisexual or questioning, - were seriously considering suicide. Transgender youth - not included in this government survey - is a group that is clearly just as, if not more, vulnerable to the same risk factors, according to research.
Mandatory Suicide Prevention Policies
Although the increasing teen suicide rate is a national crisis, much of the media spotlight has been focused on California. Surveys have shown that one in five students in the state had seriously considered attempting suicide in the past year. Futhermore, suicidal thoughts are generally most prevalent among female students and among students from multiracial, Native American and Pacific Islander backgrounds. Males, however, account for three out of every four suicide deaths.

According to Kids Data, nearly two out of three counties in California had at least one person between ages 5 and 19 die by suicide in 2013.

"90 percent of the time there's a mental health condition," Dr. Shashank Joshi, a suicide prevention expert at Stanford University, told EdSource.

Palo Alto has a teen suicide rate more than four times the national average. This affluent community with high-achieving schools saw 10 teen suicides over seven years - six during the 2008-09 school year and four in 2014-15.

The "suicide cluster" in Palo Alto, which attracted national headlines, placed high-stress academic environments under the microscope.

Charles Shannon is in his 29th year of teaching in Orinda, another high-performing district about 40 miles northeast of Palo Alto. He sees similar trends at his school.

"There are lot of pressures. Teachers and parents all want students to achieve but we are all seeing signs of stress, substance abuse, addiction," say Shannon. A vocal advocate for creating friendlier and safer environments for LGBTQ students, Shannon stresses the importance of strong anti-bullying programs but also a more inclusive curriculum.

NEA School Crisis Guide
Knowing what to do in a crisis can be the difference between stability and upheaval. A new step-by-step resource created by educators for educators can make it easier for all educators, including union leaders, school district administrators, and principals, to keep schools safe-before, during, and after a crisis.

California is taking action to help safeguard the health and wellbeing of teenagers across the state. In 2013, the legislature passed AB2246 , a law that requires all public school districts and charter schools serving students in grades 7-12 develop a suicide prevention policy.

The law mandates that these new policies be in place by the 2017-18 school year and must be developed in consultation with school and community stakeholders, school-employed mental health professionals, and suicide prevention experts. The policies must provide strategies and guidelines and resources, not only to address suicide prevention, but also intervention and postvention. (A model school youth suicide prevention policy can be found at the California Department of Education's website: http://www.cde.ca.gov/ls/cg/mh/index.asp.)

The Heard Alliance, a community alliance of health care professionals in the San Francisco area, released a comprehensive resource that serves as the implementation tool for AB2246. The "Toolkit for Mental Health Promotion and Suicide Prevention" is designed to support school communities - parents, teachers, school personnel, counselors and health providers - in improving the well-being of their students. Originally published in 2013, the resource was updated in 2017 as schools began to deisgn their suicide prevention policies. Users can find a wide variety of tools. Although created to support suicide prevention in California, any school in any district in the nation can find valuable and accessible information in the guide.

Though data informs about a great deal it does not paint the entire picture. It cannot quantify the grief, anguish, confusion, guilt and devastation felt by the family, friends and community of an adolescent who dies by suicide. It does not inform about the increased risk youth face for PTSD, other mental health problems or even their own suicide after the loss of a peer to suicide. It does not reveal the uncomfortable reactions evoked by suicide; the fear, blame, isolation, stigmatization, silence and secrecy that surrounds suicide.

Suicide is a major, preventable public health problem. Reducing the number of suicides requires the engagement and commitment of people in many sectors including education." - from the Heard Alliance's "Toolkit for Mental Health Promotion and Suicide Prevention"

Mary Ellen Flannery contributed to this story

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As Teen Suicide Rate Increases, States Look to Schools to Address Crisis

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In April 2018, the Centers for Disease Control (CDC) reported that the suicide rate among U.S. youth, ages 10 to 17, had increased by 70 percent between 2006 and 2016. According to a separate study, the CDC found that among young girls, ages 15 to 19, the suicide rate doubled from 2007 to 2015, its highest point in 40 years.

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Texas Health and Safety Code § 161.325
According to this statutory law, the Texas Health and Safety Department along with TEA
and education centers in the region must annually provide updated lists of best practice programs
as well as research based practices for suicide prevention for all public elementary, middle,
junior high, and high schools.
Already existing suicide prevention programs, any courses or programs created by the
state about suicide prevention, and programs recognized by the Suicide Prevention Center will be
WORKING WITH SUICIDAL STUDENTS 4
taken into account when created each school’s suicide prevention program. The school must
provide the training to each employee at least once and must keep a record of all employees who
received the training.
The suicide prevention program must include training for all counselors, teachers,
administration, nurses, other staff, and any law enforcement or social workers who work with
students on a regular basis. This program must teach employees ways to recognize students at
rick of suicide, early warning signs, and teach effective intervention. There should also be a
procedure implemented for notifying parents of their student’s suicide risk (Tex. Health and
Safety Code § 161.325).

2 Tex. Health and Safety Code § 161.325 (2017).

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Texas Education Code § 11.252
According to this statutory law, all districts are required to have a district improvement
plan, updated annually by the superintendent and a district level committee. This district
improvement plan must address numerous topics, including suicide prevention programs. The
suicide prevention programs within the district improvement plan must alight with the Texas
Health and Safety Code § 161.325, which specifically addresses the protocol for notifying
parents and guardians of their child’s suicide risk (Tex. Ed. Code § 11.252).

2 Tex. Ed. Code § 11.252 (2017).

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EDUCATION CODE CHAPTER 11. SCHOOL DISTRICTS

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Sec. 11.002. RESPONSIBILITY OF SCHOOL DISTRICTS FOR PUBLIC EDUCATION. The school districts and charter schools created in accordance with the laws of this state have the primary responsibility for implementing the state's system of public education and ensuring student performance in accordance with this code.

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Texas Education Code § 21.451
According to this statutory law, all educators must receive suicide prevention training as
part of their staff development. This must be done at new teacher orientations for new hires.
Employees who are already faculty must be trained in suicide prevention as of September 30th,
2016. This training must be in compliance with the Texas Health and Safety Code §161.325
(Tex. Ed. Code § 21.451).

2 Tex. Ed. Code § 21.451 (2017).

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Eisel v. Board of Education of Montgomery County
This judicial court case discusses a thirteen year old girl who committed suicide. Due to
her close relationship with her school counselors, the father sued the district as well as the
counselors for failure to notify his wife and him about his daughter’s suicide risk. He claimed it
was the duty of the counselors to report the daughter’s suicide ideations to the parents, which
they neglected to do. The courts decided that the counselors were not at fault, though the case
raised many thought, questions, and discussions about the responsibility of the counselor and
other employees when dealing with students with suicidal risks and ideations. Ethically, the risk
of not informing parents is far greater than the possible implications of not reporting, therefore,
counselors have a duty to inform parents and allow them an opportunity to choose the best path
for the protection of their children (Eisel v. Board of Education of Montgomery County, 1991).

Eisel v. Board of Education of Montgomery County, 324 Md. 376, (1991).

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Angelo State University - Library Online Resources

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Unauthorized use is prohibited; Usage may be subject to security testing and monitoring; Misuse is subject to criminal prosecution; No expectation of privacy except as otherwise provided by applicable privacy laws.

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According to the Azle ISD School Board Manual, Azle ISD must include procedures for providing parents/guardians with notice that their student is suspected to be at risk of committing suicide. This may be implemented by one employee acting as the suicide prevention liaison for the district. The district must also provide parents with available counseling alternatives for students who are at risk of committing suicide (Azle ISD School Board Policy Manual, 2017).

Azle ISD. (2017, November 8). Board Policy Manual, Student Welfare Crisis Intervention. Retrieved from: https://pol.tasb.org/Policy/Download/1109?filename=FFB(LEGAL).pdf

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In the American School Counselor Association’s Code of Ethics, code A.9.a requires counselors to inform parents and guardians if a student is suspected of being at risk of self-harm or suicide. Appropriate authorities should also be notified if the risk is serious enough. Parents should always be informed if their students is suspected of suicidal ideation, as the risk of not informing parents is far too great, and parents must be given an opportunity to parent their child as they feel is needed (American School Counselor Association, 2016).

American School Counselor Association. (2016). ASCA Ethical Standards for School Counselors. Retrieved from ASCA: https://www.schoolcounselor.org/asca/media/asca/Ethics/EthicalStandards2016.pdf

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This resource "toolkit" by the Substance Abuse and Mental Health Services Administration can be downloaded by any person. It provides information about suicide, protocols to implement if a student is at risk of suicide, steps to take after a student commits suicide, and tools and training for educators, parents, and teachers (The U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Mental Health Services, 2012).

The U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Mental Health Services. (2012). Preventing Suicide: A Toolkit for High Schools. Retrieved from SAMHSA: https://store.samhsa.gov/system/files/sma12-4669.pdf

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1. Never leave a student alone who might be at risk of suicide.
2. Always contact the parents/guardians of students suspected of suicide risk.
3. If using risk assessments rush as the Columbia Suicide Severity Rating Scale, do not take the results lightly. Always contact the parents, even if the risk is rated low.
4. Have a suicide prevention plan in place for the school.
5. Have a list of facilities and outside counseling alternatives for the parents/guardians of the student.
6. If the student is at moderate to high risk for suicide, have parents come pick up their student and have an action plan for providing the student assistance.
7. If the parents cannot pick up their student, have the police transport the student to the emergency room.
8. Stay calm for the student and the parents/guardians.