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Responding to Suicide in School Communities: An Examination of Postvention Guidance from Expert Recommendations and Empirical Studies

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Abstract

Purpose of Review

We review the published literature on a school’s response after a student dies by suicide (“postvention”). We examine published recommendations based on expert guidance and empirical studies that have evaluated postvention measures.

Recent Findings

Experts recommend careful communication with family, staff, and students that adheres to published suicide reporting guidelines. Experts also emphasize the importance of identifying and supporting high-risk students. Few robust, controlled studies have identified effective postvention measures. Effective measures tended to occur in group settings (e.g., group therapy), focus on improving grief symptoms, and involve mental health professionals.

Summary

Postvention has not been robustly studied in the school context. Expert recommendations and a few evidence-backed studies provide the frame for a coherent, school-based postvention response. Further research is needed to strengthen and expand our collective understanding of effective postvention measures in the school context as youth suicide attempts continue to rise.

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Authors and Affiliations

  1. Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N. Wolfe St., Meyer 3-181c, 21287, Baltimore, MD, USA

    James Aluri

  2. Child and Adolescent Psychiatry, New York-Presbyterian Hospital Columbia and Cornell, New York City, NY, USA

    Jessi M. Haddad

  3. Div. of Law & Psychiatry, Yale School of Medicine, Department of Psychiatry, New Haven, CT, 06511, USA

    Susan Parke

  4. Medical Director, Community Forensic Services, Connecticut Mental Health Center, New Haven, USA

    Susan Parke

  5. Wellness and Student Life, CUNY School of Medicine, New York, USA

    Victor Schwartz

  6. Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, Stanford, USA

    Shashank V. Joshi

  7. Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, USA

    Meera Menon

  8. Center for Bioethics, Harvard Medical School, Boston, USA

    Rachel C. Conrad

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  1. James Aluri
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  2. Jessi M. Haddad
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  3. Susan Parke
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  4. Victor Schwartz
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  7. Rachel C. Conrad
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Correspondence to James Aluri.

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Appendix

Appendix

Part 1: The four columns in this table describe all categories of recommendations for the guides published by Active Minds, AFSP & SPRC, Headspace, and Headspace Delphi

Category

Active Minds

AFSP & SPRC

Headspace

Headspace Delphi

Communication

- Talking about the suicide

- Inform the school community

- Keep staff well-informed, ensure regular staff meetings

- Liaising with the deceased student's family

- Promote Mental Health Resources

- Reach out to parents

- Inform students

- Informing staff of the suicide

- Psychoeducation about suicide and mental illness

- Work with the media

- Inform parents, keep parents informed

- Informing students of the suicide

- De-stigmatize mental health

- Social media

- Inform wider community

- Informing parents of the suicide

- Mental health promotion and education

 

- Help the media report on the incident in an appropriate manner

- Informing the wider community of the suicide

  

- Liaise with family

- Dealing with media

  

- Mental health information sessions

- Internet and social media

  

- Managing social media

 

Critical incident review

- Review existing policies

 

- Conduct a critical incident review

- Conduct a critical incident review

Identifying and supporting those at risk

- Provide opportunities for reflection and healing

- Helping students cope

- Monitor students and begin assessments of those identified as being at risk

- Identifying and supporting high-risk students

 

- Create a culture of healing and support

- Schedule meetings with students in small groups

- Set up a support room for students

- Ongoing support of students

 

- Support each other

- Help students identify and express their emotions

- Contact relevant mental health services

- Ongoing support of staff

  

- Identify and monitor at-risk students

- Monitor student wellbeing

- Continued monitoring of students and staff

  

- Connecting the community to mental health resources

- Monitor staff wellbeing

 
  

- Suicide clusters

  

Immediate crisis response

 

- Get the facts

- Ensure immediate safety for others

- Managing a suspected suicide that occurs on school grounds

  

- Activities for responding to a crisis

- Find out the facts

- The deceased student's belongings

  

- Tools for crisis response

- Ensure that affected individuals are not alone

 
   

- Protect the student's belongings for the police and family

 

Memorials

 

- Anniversaries and special events

- Plan the school’s involvement with funeral

- Funeral and memorial

  

- Funerals and memorial services

- Memorials

- Yearbook and newsletter

  

- Other situations (e.g., online memorials, yearbooks, graduation)

- Plan for anniversaries, birthdays, other school events of relevance

 

Organizing a team

- Organize mental health and suicide prevention task forces

- Mobilize a crisis response team

- Convene emergency response team

- Developing an emergency response plan

  

- Working with the community (review multiple community roles)

 

- Annual review of the emergency response plan

  

- Bringing in outside help

 

- Forming an emergency response team

    

- Activating the emergency response team

Other

 

- Address cultural diversity

- Ensure good documentation

- Documentation

Returning to Routine

  

- Ensure regular school routine

 

Includes checklist

  

 +

 

Includes template documents (e.g., letters, media statements)

 

 +

 +

 

Year

2017

2018

2012

2015

Part 2: The four columns in this table describe all categories of recommendations for the guides published by HEARD, HEMHA, NCSCB, and South Australia

Category

HEARD

HEMHA

NCSCB

South Australia

Communication

- Notify school community

- General communication considerations

- Inform staff

- Inform staff, keep them informed

- Organize staff meeting

- Communicating with friends of the deceased

- Involve the public information officer for the school district

- Inform students via a prepared script in small groups

- Minimize risk of suicide contagion by working with the media

- Communicating with staff

- Inform students

- Keep parents informed

- Communicate with and support broader school community

- Communicating with family of the deceased

- Inform family, prepare a statement

- Inform wider community with a prepared letter

- Designate someone to remain in contact with the family in weeks following the death

- Working with campus media

- Explaining mental health problems and suicide

- Work with media liaison

 

- Monitoring social media

- Talking about the suicide

- Liaise with family

  

- How to address unknown cause

- Mental health information sessions

Critical incident review

 

- Debriefing

 

- Conduct a critical incident review

Identifying and supporting those at risk

- Enhance identification and support of vulnerable students

- Clinical services

- Crisis and grief counseling and related support services

- Identify and plan support for students at risk

 

- Low risk level of suicide

- Group discussion and support sessions

- Identifying students who would benefit from additional emotional support

- Set up a support room in the school

 

- Moderate—to high risk level of suicide

- Individual clinical support

- Ongoing monitoring

- Monitor student wellbeing

 

- Extremely high risk level of suicide

- Self-care for responders

- Identify and monitor at-risk students

- Monitor staff wellbeing

 

- Support staff

- Challenge of dealing with contagion and suicide clusters

- Risk factors after a suicide

 
 

- Support students during the school day

   
 

- Provide support as needed for siblings of the deceased enrolled in the district

   
 

- Identify and support vulnerable students

   

Immediate crisis response

- Contact key individuals

 

- Notify and activate the school crisis team

- Ensure that affected individuals are not left alone

   

- Handling the student’s belongings

- Find out the facts / circumstances as far as possible

    

- Ensure immediate safety of community members

    

- Inform relevant authorities

    

- Collect all deceased student belongings

Memorials

- Key considerations for appropriate memorialization

- Memorials and related events

- Memorials: participation of students, spontaneous memorials

- Plan school involvement with funeral

 

- Prepare for anniversaries and special events

  

- Plan for anniversaries, birthdays, significant events

Organizing a team

- Crisis response team members and roles

- Planning in advance

 

- Convene emergency response team

  

- Forming a postvention committee

  
  

- Implementing the postvention plan

  

Other

 

- Considerations when the student who died by suicide was a counseling center client

 

- Continue documentation of all actions

  

- Campus murder-suicides

  

Returning to Routine

- Process for re-entry to school after extended absence or hospitalization

- Getting back to routine

 

- Restore regular routine

 

- Coordinate implementation of long-term response protocol

   

Includes checklist

   

 +

Includes template documents (e.g., letters, media statements)

 +

 +

 

 +

Year

2013

2014

2017

2010

This Appendix provides a synthesis of the content covered by each of the guidelines as primarily derived from the table of contents for each guidelines, but also from a close review of the internal content. Content headers were taken verbatim from the guidelines wherever possible, with only occasional editing for clarity, concision, and relevance. “AFSP & SPRC” represents the guidelines produced by the American Foundation for Suicide Prevention and the Suicide Prevention Resource Center. Headspace had two guidelines, one labelled as a suicide postvention toolkit (referred to as “Headspace toolkit” above) and a Delphi study on responding to suicide in secondary schools (referred to as “Headspace Delphi” above). HEARD stands for the Health Care Alliance for Response to Adolescent Depression. HEMHA stands for the Higher Education Mental Health Alliance. NCSCB stands for the National Center for School Crisis and Bereavement at Children’s Hospital Los Angeles. “South Australia” refers to the guidelines published by the Government of South Australia in conjunction with the Catholic Education South Australia and the Association of Independent Schools of South Australia.

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Aluri, J., Haddad, J.M., Parke, S. et al. Responding to Suicide in School Communities: An Examination of Postvention Guidance from Expert Recommendations and Empirical Studies. Curr Psychiatry Rep 25, 345–356 (2023). https://doi.org/10.1007/s11920-023-01431-x

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