Strategies for Suicide Prevention Amongst LGBTQ High School Students Alison Lance, BS, School Psychologist in Training Shanter H Alexander, Ed.S, CAS, NCSP

Color Cards Who is here today?

NASP Model

NASP Position Statement (2011) Lesbian, Gay, Bisexual, Transgender, and Questioning Youth “NASP believes that school psychologists are ethically obligated to ensure that all students have an equal opportunity for the development and expression of their personal identity in a school climate that is safe, accepting, and respectful of all persons and free from discrimination, harassment, violence, and abuse. To achieve this goal, education and advocacy must be used to reduce discrimination and harassment against LGBTQ youth by students and staff and promote positive social-emotional and educational development.”

Youth and Young Adult Suicide Suicide is the 2nd leading cause of death for youth and young adults ages 15–24 in the United States. Over 4,800 youths and young adults ages 15–24 commit suicide/year. About 1 out of every 13 high school students attempts suicide each year. Individuals in the LGBTQ community are up to 7x more likely to attempt suicide. Centers for Disease Control and Prevention, YRBS, 2014

Most importantly, suicide can often be prevented. Suicide is a major public health issue, meaning: Suicide affects large numbers of people. Prevention is based on research that is mostly related to risk factors. Most importantly, suicide can often be prevented.

Session Objectives Use correct terminology for suicidal behavior and LGBTQ issues. Describe research related to suicidal behavior among LGBTQ youth. Discuss risk and protective factors for suicidal behavior in LGBTQ youth. Assess the cultural competence of schools in relation to LGBT youth, and plan next steps for increasing LGBTQ cultural competence. Describe strategies to reduce suicidal behavior among LGBTQ youth.

What causes suicide? Individual, family, and social? Mental illness? Depression and anxiety There are other risk factors associated with suicide, including: Previous suicide attempt(s) Firearm ownership Isolation Hopelessness Impulsivity and recklessness Family discord and dysfunction On-going exposure to negative events such as abuse/neglect or bullying/peer victimization.

Terms – Suicidology Suicide death Attempted suicide Suicidal ideation Suicidal behavior Terms – Suicidology

Suicidal Ideation in LGBTQ youth LGBTQ youth are 1½ to 3 times more likely to report suicidal ideation than non-LGB youth. 48% of LGBTQ youth ages 14-21 said suicidal thoughts were clearly or at least somewhat related to their sexual orientation.

Suicide Attempts in LGBTQ Youth LGBTQ youth are 2 to 7 times more likely to have said they attempted suicide than non-LGB youth. LGBTQ youth attempts may be more serious, based on some initial findings about: Intent to end their lives Lethality Suicide Prevention Resource Center, 2008 Kann et al., 2011

Suicide Death among LGBTQ Youth There is no reliable or official way to determine rates of suicide deaths in people who are LGBTQ because death reports and certificates do not usually include the person’s sexual orientation. Compared to non-LGB youth: LGB youth have higher rates of suicide attempts. LGB youth suicide attempts may be more serious.

Suicide Behavior and Transgender Youth Did you know that… 46% of transgender youth under the age of 26 will attempt suicide AND 59% self-harm on a regular basis?

Risk and Protective Factors Being LGBTQ is not itself a risk factor for suicidal behavior BUT social stigma and discrimination unsafe schools and bullying are associated with mood, anxiety, and substance use disorders, and suicidal behavior.

Rural vs. Urban In general, rural LGBTQ students tend to find faculty or staff less supportive and feel less connected to their schools than suburban and urban students. Rural LGBTQ youth might be at particularly high risk due to lower levels of support and fewer resources in rural schools and communities. Ballard et al., 2017

Protective Factors Family connectedness Family acceptance Safe schools Caring adult High self-esteem Positive role models Kosciw et al., 2014

Risk Factors Gender nonconformity Internal conflict about sexual orientation Early coming out Low family connectedness Lack of adult caring Unsafe school Family rejection Victimization Bullying Stigma and discrimination perceived burdensomeness feeling that one doesn’t belong Baams et al., 2015 and Kosciw et al., 2014

Game Plan What can you do?

School Policies Check your school or agency anti-discrimination policies for both sexual orientation and gender identity. Explicitly including LGBTQ issues gives legitimacy to LGBTQ concerns. (NASP, 2011).

Make your support visible Student who could identify with ONE adult staff member who supported the LGBTQ community felt safer at school. LGBTQ students are more likely to feel comfortable talking with school staff about LGBTQ issues. Kosciw, 2016

Review availability of information on LGBT youth issues Check your school library, or add some books to your own collection. Books for parents Books about LGBTQ heroes (those in a protagonist role) Biographies about LGBTQ individuals Documentaries about LGBTQ individuals Suicide Prevention Resource Center (2014)

Intervene Interrupt a student who is using a derogatory term, and report it. The negative affects of bullying are positively correlated to suicidal ideation and suicide attempts. In one study, only about 1/3 of students reported teachers intervening when they felt victimized at school. Ballard, 2017, Camera, 2016 and Kosciw, 2016

Harassment & Assault Verbal and physical harassment, and physical assault are addressed in research. Harassment and assault occur frequently because of a youth’s sexual orientation, and gender expression. Kosciw, 2016

Attend or Help Start a GSA GSAs positively impact the school climate for LGBTQ students. A better school climate is negatively correlated with suicidal thought, suicide plans, and suicide attempts of LGBTQ students (Hatzenbuehler, Birkett, Van Wagenen & Meyer, 2014)

Inclusive Curriculums Only 22.4% of LGBTQ students were taught positive representations about LGBT people, history, or events in their schools 17.9% had been taught negative content about LGBT topics. Staff and (especially) students should be educated on: Gender identity Sexual orientation Homophobia Institutionalized discrimination Kosciw, 2016

Gatekeeper Training Recognize someone at risk for suicide, Intervene with those at risk; and, Refer them to an appropriate resource. Reduction of risk factors, increase in protective factors.

Gatekeeper Resources Take a gatekeeper training (e.g., QPR, ASIST, Connect) to learn how to identify youth who may be having suicidal thoughts http://www.sprc.org/search/bpr/Gatekeeper%20training?filters=sm_resource_ type%3Abpr_listing Take a gatekeeper training from the Trevor Project that focuses on LGBT youth http://www.thetrevorproject.org/section/education-training-for-adults Contact your state suicide prevention coalition to find gatekeeper training in your area http://www.sprc.org/search/bpr/Gatekeeper%20training?filters=sm_resource_ type%3Abpr_listing Encourage your local referral network to be trained in assessing and managing suicide risk http://www.sprc.org/traininginstitute/amsr/clincomp.asp

The 2015 National School Climate Survey, GLSEN https://www. glsen

The 2015 National School Climate Survey, GLSEN https://www. glsen

Crisis Line Resources Suicide Prevention Crisis Lines National Suicide Prevention Lifeline Phone: 1-800-273-TALK (8255), available 24/7. For Spanish, call 1-888-628-9454 Online chat: 2 pm – 2 am http://www.suicidepreventionlifeline.org/GetHelp/LifelineChat.aspx Trevor Lifeline: 866-488-7386, available 24/7 TrevorText: Available only specific hours. Text “Trevor” to 1-202-304-1200. TrevorChat: Online only specific hours. For hours, go to http://www.thetrevorproject.org/pages/get-help-now

References Ballard, M. E., Jameson, J. P., & Martz, D. M. (2017). Sexual identity and risk behaviors among adolescents in rural appalachia. Journal of Rural Mental Health, 41(1), 17-29. doi:http://dx.doi.org.ezproxy.andrews.edu/10.1037/rmh0000068 Baams, L., Grossman, A. H., & Russell, S. T. (2015). Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Developmental Psychology, 51(5), 688-696. doi:http://dx.doi.org.ezproxy.andrews.edu/10.1037/a0038994 Centers for Disease Control and Prevention. (2014). Youth risk behavior surveillance - United States, 2013. Surveillance Summaries. MMWR, 63(4). Retrieved from http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual, and transgender youth in our nation’s schools. New York, NY: Gay, Lesbian, & Straight Education Network. National Association of School Psychologists. (2011). Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth (Position Statement). Bethesda, MD: Author.

References Suicide Prevention Resource Center (2014) Suicide Prevention among LGBT Youth: A Workshop for Professionals Who Serve Youth. Retrived on Oct 30. from http://www.sprc.org/resources- programs/suicide-prevention-among-lgbt-youth-workshop-professionals-who-serve-youth-0