Evaluating Suicide-Prevention Programs
Sorting through the sensationalism and naive theories about the causes and extent of self-destructive behavior among adolescents is a formidable task.
Research indicates that the vast majority of adolescents negotiate this period of their lives with only minor difficulties. But statistics also tell us that the number of young people who act in ways that are harmful to themselves is rising.
Suicide ranks as the second leading cause of death among those between the ages of 15 and 24. Some 5,399 young people between the ages of 5 and 24 took their own lives in 1985, and many experts believe that figure would climb higher if suicides were reported accurately. Researchers estimate there are 100 to 120 attempts for each completed suicide.
Concerns about such figures have spawned a wide range of school programs aimed at suicide prevention. Some of these efforts have been motivated by a genuine desire to help troubled adolescents, while others have originated in schools' need for legal protection from hurt and angry parents.
The proper role of schools is to identify youths who may need professional intervention, and evaluations of programs should be based strictly on this criterion. It is a mistake to view suicide as an educational rather than a societal issue, or to expect schools' prevention efforts to reduce overall suicide rates. But soundly designed programs increase the likelihood that connections will be made between caring adults and high-risk teenagers--and it is just possible that lives may be saved as a result.
In addition to their classroom component, comprehensive programs include the following elements: crisis-intervention team training; teacher inservice training; parent workshops; contingency plans for dealing with a completed suicide; committees that work to form a community network for providing services to high-risk students and their families.
Critics who suggest that school-based programs "don't work" often misunderstand the purposes and methods of these efforts. For example, David Shaffer, professor of psychiatry and pediatrics at the New York State Psychiatric Institute, claims that there "is little to support the value of general educational programs." He bases this judgment on what he calls "the only systematic, controlled evaluation of school-based programs." In this study, 1,000 students were interviewed before participating in a suicide-prevention program to determine their knowledge about the subject. According to Dr. Shaffer, the students "held views and had knowledge that would generally be considered sound."
But Dr. Shaffer attempted to evaluate only classroom activities and failed to consider the other critical elements of school-based programs. His conclusions exceed the scope of his research.
Others have contended that educators may be providing information about suicide that some students are not prepared to handle. Harold Voth, chief of staff at the Veterans Administration Medical Center in Topeka, Kan., for instance, has stated, "Some youngsters are unstable, and if you open up the subject of suicide and start probing for the causes of despair, they will walk out the door with nowhere to go with all that agony."
This warning is appropriate. Well-meaning educators should avoid showing films or performing plays about suicide, or conducting mass screenings in the classroom. Such activities cannot represent the complex behavior of suicide accurately, nor can they avoid stirring the suicidal thoughts of troubled youngsters.
Rather, any suicide-prevention activities in the classroom should be conducted by a trained mental-health professional in conjunction with a knowledgeable teacher. Curricula should be limited to teaching the signs of suicidal thinking along with basic intervention strategies--for example, avoiding involved peer counseling, referring a peer to an adult, and using school and community resources. And such instruction should be considered only after the other program components have been completed. It is unfair, if not irresponsible, to provoke students' emotions and not be prepared to deal with their needs.
Programs must clearly define their goals and monitor results as closely as possible.
Teachers, counselors, and others in the schools can play an important part in intervention--identifying troubled students and referring them to qualified professionals--but they should not assume the role of "therapist."
And while suicide prevention should be the focus of school-based programs, other types of self-destructive behavior should also be addressed. Drug abuse, teenage pregnancy, running away, cult membership, and eating disorders, for example, are all forms of self-harm; all indicate varying degrees of maladjustment or emotional disturbance. Many observers believe that some teenagers move up a "continuum" of self-destruction before reaching the point of suicide. It has been theorized that youths involved in one type of self-destructiveness are likely to be caught up in other forms as well.
Separate efforts for each such behavior may be neither cost-effective nor desirable. With suicide prevention as their object and identification of adolescent pathology as their primary strategy, integrated programs can become the most effective means for helping young people.
Evaluation is likely to remain an issue for some time. Plans that promise to reduce the suicide rate in a given geographic area will probably fail to do so--not because they have not done their best for their students but because they have assumed too large a share of the responsibility for preventing suicides. Schools should not attempt to countervail the lack of responsiveness in local communities--if not the entire society--to the needs of children and teenagers.
In addition to individual case studies, assessments of suicide-prevention programs must consider the quality of training that school care-givers receive, their practical experience in applying this training with high-risk students, the number of interventions completed, and their longterm outcomes.
The need for such evaluations is urgent. Much of the current research on the effectiveness of these programs is methodologically weak. The fact that field research is often more difficult to conduct than laboratory research is no excuse not to gather data.
And for school programs to be more successful in their work with self-destructive students, other community agencies will have to resolve their "turf" issues. Some professionals and agencies wrongly believe that they know more than any other group or individual about working with suicidal youths. This competitive attitude has created boundaries that serve only to ensure that youngsters and families who need help will continue to fall through the cracks.
Self-destructiveness among young people is a sign of the times that is not going to magically disappear. Only when children's well-being becomes a higher priority in our society--and not just in schools--will the war against such behavior be won.
We must begin to isolate those biological and environmental aspects of children's lives that may cause them to become self-destructive and try to change them. But until we can move forward on this course, comprehensive intervention programs offer a first line of defense and send a message to our young people that we care about them.
Vol. 09, Issue 12, Page 28Published in Print: November 22, 1989, as Evaluating Suicide-Prevention Programs