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The Role of Teachers in School-Based Suicide Prevention: A Qualitative Study of School Staff Perspectives

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Abstract

In response to concerns over youth suicide, there has been an increase in school-based suicide prevention programs. However, we know little about teacher perspectives on school-based suicide prevention and mental health programs. This study examined teacher roles in the implementation of a district-wide suicide prevention program through focus groups and interviews with middle school teachers, administrators, and other school personnel. Study results highlighted teachers’ critical role in detecting students at risk for suicide. Factors that appeared to facilitate teacher participation in the suicide prevention program included well-defined crisis policies and procedures, communication of these procedures, collaboration across staff, and the presence of on-campus mental health resources. Participants identified a need for direct teacher training on risk factors for suicide, crisis response, and classroom management. Other strategies for improving suicide prevention efforts included in-school trainings on mental health resources and procedures, regular updates to these trainings, and greater visibility of mental health staff.

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Acknowledgments

Support for this study was provided by the NIMH (R21MH068623). We would like to thank Rich Lieberman for his support of this project and the teachers, principals, social workers, and school staff of the participating schools for sharing their experiences with us.

Author information

Authors and Affiliations

  1. Division of Mental Health Services and Policy Research, New York State Psychiatric Institute, Columbia University, New York, NY, USA

    Erum Nadeem

  2. Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA

    Sheryl H. Kataoka

  3. UCLA Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA

    Sheryl H. Kataoka & Pamela Vona

  4. Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA

    Vickie Y. Chang

  5. School of Social Work, University of Southern California, Los Angeles, CA, USA

    Marleen Wong

  6. RAND Corporation, Pittsburgh, PA, USA

    Bradley D. Stein

  7. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA

    Bradley D. Stein

Authors
  1. Erum Nadeem
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  2. Sheryl H. Kataoka
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  3. Vickie Y. Chang
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  4. Pamela Vona
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  5. Marleen Wong
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  6. Bradley D. Stein
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Corresponding author

Correspondence to Erum Nadeem.

Appendix

Appendix

Focus Group Guide

Detection

Let’s start by talking about the different ways that students at your school are recognized as possibly being at risk for suicide. Briefly, can someone walk me through a specific case? Have others had different experiences?

Prompts:

  • How do you draw the line between being not concerned to concerned?

  • How do you detect students at risk?

  • How could detection be improved? What support would be helpful?

  • Do you consult before you refer? If so, with whom? Are these formal or informal mechanisms?

  • What kind of information sharing occurs at different stages of the process?

  • How are teachers made aware of mental health resources on campus?

  • What is the role of teacher, counselors, and administrators in detection?

  • How do/not teachers, counselors, administrators work collaboratively?

Crisis Intervention

Once a student at your school is considered at risk for suicide, what happens next? Walk me through the process.

Prompts:

  • Protocols/procedures—how do students get evaluated, who does it?

  • Documentation—forms, who fills it out. Do you fill out the [required district form]?

  • If someone should know about the [required district form] but does not, try to find out why they do not know about it.

  • Find out about other forms, where they came from, who has access to them

  • Resources/staff/programs in regard to suicide

  • Support services—on campus or nearby? What is process to access?

  • Parental involvement

  • What is the role of teacher, counselors, and administrators in intervention?

  • How do/not teachers, counselors, administrators work collaboratively?

  • What makes your role in helping a student at risk for suicide easier or harder?

  • Are there written guidelines for responding to crisis. If so, where do they come from, who has access to them, how much are they used?

Post-Crisis

What type of follow-up by the school staff typically happens and by whom?

Prompts:

  • What would better help you to support students after a suicide-related crisis?

  • Parents/outside agencies/hospitals contacted for follow-up information?

  • In school follow-up?

  • When follow-up occurs, find out how staff makes time.

  • Determine whether there are procedures about confidentiality, what school policy dictates.

Training

What type of training have you received regarding students at risk for suicide?

Prompts:

  • Training topics (e.g., risk factors, how to detect at risk students, what to do in crisis, how to follow-up)

  • Specific training within school on how each staff person should respond?

  • District training (e.g., by [the director for suicide prevention])?

  • Training for teachers versus counselors versus administrators?

Quality Improvement

Now I would like us to talk about how suicide prevention efforts can be improved both at your school and at the district level.

Let’s start with what can be done at the school level. If you were going to try to improve or change what your school does to help students who may be at risk for suicide, what would you do?

Prompts:

  • Detection of students at risk?

  • Support services during the crisis?

  • Post-crisis period?

  • Training?

  • Personal time and resources, suggested modifications?

Now let’s discuss what can be done at the district level. If you were going to try to improve or change what happens district-wide for students who may be at risk for suicide, what would you do?

Prompts:

  • Detection of students at risk?

  • Support services during the crisis?

  • Post-crisis period?

  • Training?

Middle versus high School

  • Suicide is sometimes considered a topic that high schools are more concerned about than middle schools. Do you think there are differences in how middle versus high schools should respond to students at risk for suicide?

  • Do middle schools have unique needs?

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Nadeem, E., Kataoka, S.H., Chang, V.Y. et al. The Role of Teachers in School-Based Suicide Prevention: A Qualitative Study of School Staff Perspectives. School Mental Health 3, 209–221 (2011). https://doi.org/10.1007/s12310-011-9056-7

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