November begins the dark winter season in the Pacific NW and is also a time when expectations ramp up for students.  Many schools are taking time to improve suicide prevention and student mental health support.  So, for this month’s Ask Nancy, we look at questions about Suicide Prevention Training and How to Detect Warning Signs.


Our school nurse is looking to get trained on current suicide prevention concepts.  Where can he look for this information?

Nancy says:

According to the OSPI website, in Washington State suicide is the second leading cause of death for teens 15 to 19 years old.  One study found that almost 40 percent of people have a healthcare visit within a week prior to their suicide attempt. Healthcare professionals are in a unique position to notice depression and suicide warning signs in their patients and intervene early.  Suicide is a preventable public health issue.  Understanding the stressors and hopelessness that lead people to consider suicide and connecting them to the appropriate help can save lives.

Health professionals who need to take a training must choose an approved suicide prevention course on the 2017 Model List. These courses meet content and time requirements outlined in legislation (RCW 43.70.442).


Types of training applicable to a Health Care provider working in a school:



What are the warning signs we should be looking for when it comes to teens and kids at risk of suicide?

Nancy says:

According to the Washington Healthy Youth Survey (2016), 28% of eighth graders, 34% of 10th graders, and 37% of 12th graders felt so sad or hopeless for 2 weeks or more that they stopped doing their usual activities.   Most students who reported feeling sad or hopeless said they have an adult to turn to for help, however, 12% of 8th graders, 15% of 10th graders, and 13% of 12th graders report there are not adults for them to turn to when feeling sad or hopeless.

School staff have day-to-day contact with many young people, some of whom experience mental distress or illness that could result in feelings of hopelessness that could lead to suicidal behavior. Those who work in schools are well-positioned to observe students’ behavior and act when they suspect that a student may be at risk of self- harm and/or suicide.

Specific steps should be followed in order to identify and help young people at risk, including a referral to someone in the school who has been trained to assess suicide risk. School systems should include efforts to recognize the warning signs, refer students to appropriate resources, and create reentry plans for students coming back to school after a crisis that coordinate with mental health treatment plans.

The OSPI website offers this checklist to help school communities know the warning signs and how to take action:


Additional information can be found on the OSPI School Safety Center webpage on Prevention, Intervention and Postvention for Youth Suicide:

Responding to the Warning Signs:
It takes time and courage to reach out to students on a personal level, but your interest can be a lifeline to a child in crisis.

    • Ask the Tough Questions: Do not be afraid to ask a student if they have considered suicide or other self-destructive acts. Research has shown that asking someone if they have contemplated self-harm or suicide will not increase that person’s risk. Rather, studies have shown that a person in mental distress is often relieved that someone cares enough to inquire about the person’s well- being. Your concern can counter the person’s sense of hopelessness and helplessness. However, you need to be prepared to ask some very specific and difficult questions in a manner that doesn’t judge or threaten the young person you are attempting to help. For example:
      1. Sometimes when people feel sad, they have thoughts of harming or killing themselves. Have you had such thoughts?
      2. I’ve noticed you are going through some rough times. Have you ever felt your life is a burden on others? Do you ever wish you could go to sleep and not wake up?
      3. Are you thinking about killing yourself?
    • Be Persistent: The person you are contacting may feel threatened by your concern. They may become upset or deny that they are having problems. Trust your instinct and be consistent and firm, and make sure that they get the help they need.
    • Be Prepared to Act: You need to know what to do if you believe a student is in danger of harming themselves. Know the school’s procedures from the crisis response plan for this situation and explain to the student the steps you will be taking.
    • Do Not Leave a Student at Imminent Risk of Suicide Alone:If you have any reason to suspect that a student may attempt suicide or otherwise engage in self-harm, you need to remain with the student (or see that the student is in a secure environment, supervised by caring adults) until professional help can be obtained.
    • Get Help When Needed: If you believe that the student is in imminent danger, you, or another member of the school staff, should call 911 or (800) 273-TALK (8255). Tell the dispatcher that you are concerned that the person with you “is a danger to themselves” or “cannot take care of themselves.” These key phrases will alert the dispatcher to locate immediate care for this person with the help of police. Do not hesitate to make this call if you suspect that someone may be a danger to him- or herself. It could save that person’s life.
    • Use Your School’s Support System: School districts have crisis plans for working with students who are experiencing emotional or behavioral distress Familiarize yourself with these plans and use them when appropriate.
    • Connect with Parents or Guardians: Do not promise confidentiality to anyone when it comes to issues regarding their safety. If a student opens up to you about their feelings, talk privately with them about putting the steps of the school’s crisis plan in place, and include them in the conversation. Follow the school’s communication plan for contacting parents or guardians when a student is at risk. If you believe that contacting the parents or guardian may further endanger the child (if, for example, you suspect physical or sexual abuse), contact the proper authorities. School staff are mandated reporters and are required to report suspected child abuse.