Understanding Risks, Warning Signs And Prevention Of Suicide After Communal Trauma

Mar 26, 2019

Mental health providers in South Florida are stressing the need for more trauma awareness and suicide prevention resources following the apparent suicide deaths of two young survivors of last year's shooting at Marjory Stoneman Douglas High School.

Health News Florida spoke with Dr. Nicole Mavrides, child psychiatrist and professor at the University of Miami, about suicide as a public health issue. Mavrides is also a graduate of Marjory Stoneman Douglas High School.

If you are hurting and need to talk with someone now, you can call your community help and crisis hotline: 2-1-1 in all South Florida counties, and the Keys. You can also call the National Suicide Prevention Lifeline at 1-800-273-8255 to talk to a trained counselor.

Health News Florida: What are some of the signs that someone might hurt themselves?

Mavrides: We look for impulsivity or talking about self harm. We also have to look for the kids who are depressed, who are withdrawn, who are isolating themselves, who maybe are wearing long sleeves when it's 90 degrees out. Those are things that maybe there's some indication that they've either started to hurt themselves or are thinking about it.

When you say impulsivity, how do you know what's a teenager being a teenager and what's a teenager who is in danger of possibly hurting themselves or killing themselves?

It's hard but the impulsivity that we're looking for are risky behaviors. Staying out ridiculously late when they never used to. Or getting into trouble with drugs and alcohol. Stealing. Going on a lot of dates or sleeping with somebody—doing something that maybe is just really out of character. That maybe is not in the norm of the regular teenage behaviors.

And we've been encouraging people to call the National Suicide Prevention Lifeline, 1-800-273-8255, or numbers like 211. What can people expect if they make that call?

There are certified counselors on the other line of the suicide hotline. Those are people who are trained to talk to kids or adults who are feeling suicidal or having those negative thoughts. They're going to find out whether or not the [callers] want to act, or is it just kind of these vague thoughts—and they can help direct them to go see a medical professional, call their hospital, call an ambulance, go talk to their parents. A lot of times it is just a kid who's having negative thoughts, and they're able to talk them down and kind of get them to the point where they're feeling safe.

Then 211 is more for giving them direction on how to get the help that they need. So they will provide the person who's calling them with information on mental health clinics or providers in their area.

At what point should you just call 911 if you or someone you know appears to be on the verge of potentially killing themselves?

If you're worried that this person is going to hurt themselves and there's imminent danger of them hurting themselves, or if they're actively doing something, you have to call 911.

These kids have shown that if they want to hurt themselves, they're going to figure out ways of doing it. So there's no way of keeping an eye on someone 24 hours a day. If there's even a consideration, it's much safer to call 911 or go to an emergency room and at least be seen by a mental health provider.

How much a threat is suicide to the MSD community and other communities that have experienced trauma?

We know that post-traumatic stress and catastrophic events can cause depression. And there can be suicidal thoughts. But we really now are seeing that there's a big risk and that's why we want to get these kids the help that they really need to make sure that someone is looking out for them.

Usually the first six months following an event are the scariest because it's the most acute. But then after that, it's anytime there's an anniversary. And anytime that there's something significant. But we still see that people who are affected, it can happen at any time.

My colleagues and I are aware of the suicide contagion effect—and this has been pretty well studiedthat depending on how they're represented, stories about suicide can encourage people who are at risk of self harm. And there are some communication standards that we're working to follow. But, who's at risk of being triggered just by the news?

The kids who are at risk are the kids who were already thinking about it.

This is not going to put new thoughts into kids' heads who were never depressed. These are kids who had had the thoughts and maybe they're like, "wow, that person did this, they were brave." We want to prevent that from happening.

If you start to feel that the news is too much, if it's making you feel sad, or it's giving you negative feelings, that's the time to turn it off. That's also the time to go and talk to someone about those feelings. To talk to your parents. Talk to a mental health professional. To talk to even your friends.

If you know someone who's hurting, how can you support them?

Just letting them know that you're there. And also helping them to make that decision to tell someone else.

If you're a kid and you know someone in your classes that is suffering from depression or are suffering from cutting behaviors, or things like that—be there for them, but also maybe encourage them to go and talk to an adult.

If there's something that they're really concerned about, then they need to go and tell somebody for them. Because that could be saving their life.

We're in the middle of our state legislative session. What do you want the people who make policy and budgets to understand about the mental health needs of our community?

We need drastically more providers. So we need more money in the state budget to allow for more hiring. We need more programs that are going to train these providers. We need people who are going to get psychology degrees. And we need to be able to go into the school systems and have counselors who are trained in these things, to work with the kids who have been affected.

If you have been affected by the shooting at Marjory Stoneman Douglas High School, you can call 305-355-9021 to get an expedited appointment with Mavrides's practice.