Before they dove into discussions about technology updates and special education, administrators and principals in the Coeur d’Alene School District began a Wednesday morning management retreat with training in suicide-prevention techniques.
The session was a grim reminder of four suicides by district students within the past 15 months. Two were by juniors at Lake City High School who died within about three weeks of each other. Another, last June, was by a middle school student. The fourth, this past June, was by a student who had recently withdrawn from a district middle school.
But the practice session also was an indicator of the district’s resolve to prevent more deaths and ensure the mental health of its students. In the coming semester, the district intends to train all 1,300 staff members and all high school students in a nationally recognized suicide prevention technique called QPR, which stands for question, persuade and refer.
“We could go five years and not have another teen suicide,” said Superintendent Hazel Bauman, pointing out that many school years have passed with none. But, she said, “the more the community is aware of suicide and the more we have some resources to help people, then the suicide rates will go down.”
QPR was developed 15 years ago by Dr. Paul Quinnett, a Spokane psychologist and suicide prevention expert, and is intended to raise awareness and make anyone able to intervene and save a life. It teaches people how to identify signs of depression in their peers, question them about whether they’re suicidal and help them seek assistance from mental health professionals.
Quinnett draws an analogy to CPR – training that millions of people have used to save lives. QPR can do the same thing: intervene in a potentially life-threatening situation long enough to get people the professional medical help they need.
The district’s response has been embraced by the larger Kootenai County community, as a collection of medical and social services providers – a group called Community Linkages – have simultaneously adopted suicide prevention as a goal and begun learning QPR techniques. A recent community health assessment conducted by Kootenai Medical Center showed that emphasizing suicide prevention could make a big difference in the region, said Kim Anderson, a hospital spokeswoman.
Idaho is consistently among the states with the highest suicide rates, and Kootenai County’s rate is higher still. Nationwide, about 11.5 deaths per 100,000 people are attributed to suicide. In Idaho, that number is 14.9 per 100,000, but in Kootenai County it jumps to 25.6 out of every 100,000.
“The goal of QPR is to have the whole community trained on a common language. It’s not only happening in the schools,” said Mike Baker, CEO of Dirne Community Health Center in Coeur d’Alene, who is requiring his 75 staff members be trained in QPR. “It’s all about raising awareness, and it’s not rocket science. The key to this is everybody in the community being aware.”
Responding to a crisis
When the school district received news of the first Lake City High suicide on April 6, it went into crisis response mode.
Its crisis intervention team – a specially trained group of counselors, school psychologists and teachers – was mobilized, and counselors told all Lake City teachers what had happened. Teachers were given a statement to read to students, telling them about the junior boy who had taken his life the night before. Students were directed to counselors stationed in the library, who remained on scene for several days. Many students talked to counselors and some were referred to mental health professionals.
A note was sent home to parents with advice on how to support grieving students, said district spokeswoman Laura Rumpler.
Slightly more than three weeks later, it happened again.
On April 29, a Friday, the district learned that another Lake City junior had taken her life the night before. Rumpler said the second incident launched fears in the district about contagion. The district increased its interaction with social service providers, law enforcement and mental health professionals.
Representatives of Kootenai Behavioral Health came to the school and took students by grade level into the auditorium to talk to them. They handed out white business-style cards to every student and asked them, before they left for the day, to write the names and phone numbers of two people they felt they could turn to for help if they needed it.
The district held a parent meeting that night on the advice of mental health experts, considering the onset of the weekend and the likelihood students would be communicating via social media. About 35 parents attended and Bauman said people in the audience were afraid. “They were coming seeking answers,” Bauman said. “We had a couple of people break down and cry, (saying) ‘I don’t know what to do. I’m so scared.’ It was that close to the surface.”
Dr. Alan Unis, medical services director for Kootenai Medical Center’s Youth Services Program, attended and talked one on one with people who felt their children were at risk. Unis said after talking to parents he realized there was a group of kids at Lake City who all were considering suicide.
“By increasing the visibility of services to them, we were able to intercede with kids who were walking down the same path,” Unis said. “Ultimately, we were able to serve all of the kids who were in that circle of acquaintances.”
Christine Ballard, mother of a recent Lake City graduate and an incoming sophomore, praised the district’s response.
“I think the district handled it very well, considering neither of the suicides happened at school,” she said. “They were on it immediately. They were there for the kids, which was the most important thing to me as a parent.”
This school year, despite “horrendous budgetary times,” Bauman said the district plans to bring back prevention specialists at the high schools and increase the number of administrators. The prevention specialists, who address issues like substance abuse, suicide and bullying, were cut when state funding for the positions was eliminated, Bauman said. District officials also are talking to city police about expanding the presence of school resource officers in the high schools.
The next step
The Wednesday morning training is representative of something that will happen over and over again in the coming school year – with teachers, with students, with bus drivers and with food preparation workers. Now that the crisis appears to have passed, the district has launched into prevention mode.
The training included information on detecting suicidal thoughts, how to respond and how not to respond. It also included role-playing to ensure everyone involved could ask the question: “Are you thinking of killing yourself?” Or “Are you thinking about suicide?”
In each pairing, one person pretended to be a teenager considering suicide and the other her best friend as they talked about her increasing depression and feelings of hopelessness. Hayden Meadows Elementary School Principal Lisa Pica, playing the best friend, promised to never leave her friend’s side until she received assistance from mental health professionals. When the exercise ended, Pica placed a hand over her heart.
“It’s very emotional,” she said. “To think that some of our kids are feeling that way … .”
The training was conducted by Cindy Perry, the district’s lead nurse, and Kelly Ostrom, human resources director. Both were trained to teach QPR on Aug. 8 when Quinnett conducted a seminar for 16 district personnel and six community members from the Community Linkages group.
Those people will become the trainers as the school year starts, conducting numerous hourlong sessions like the one held Wednesday. An additional training to create more trainers will take place in September, Bauman said. All counselors will be required to attend, and school resource officers and some administrators likely will also attend, she said.
On Wednesday, Perry and Ostrom emphasized the importance of asking people directly whether they’re considering killing themselves. Don’t say “hurting yourself” or dance around it, Perry said – ask it. Research shows using those words will not increase the chance of suicide, but will open up lines of communication and help move that person toward getting help, she said. The motto of the QPR Institute is: “Ask a question, save a life.”
Perry also pointed out that using these techniques can help reduce the violence in a community because suicidal people frequently are homicidal as well. She referenced recent news stories about suspected murder-suicides, including one last week.
The training emphasized being on the lookout for warning signs, including depression, giving away prized possessions, drug or alcohol abuse, and unexplained anger or irritability. The administrators also learned of an unexpected sign – sudden happiness in someone who has been depressed for a long time.
“We’re not talking about just students,” Ostrom said. “We’re talking about all of us.”