1. Suicide Prevention in Tennessee Community Colleges: A Case Study

2. Sandra Perley ED.D, MSN, RN Associate Professor of Nursing

3. What is Suicide? “A death from an individual’s own actions, in which the individual intended to end his or her own life” (Carballo, Stanley, Brodsky, & Oquendo, 2012)

4. Suicide in the United States 41,149 died by suicide in 2013 112.7 each day 1 every 13 minutes Each death affects the lives of 30 other people Now surpasses motor vehicle accidents as the leading cause of accidental death in this country

5. Suicide in Tennessee 52,000 Tennesseans between 18 – 29 seriously consider suicide yearly 3.6% of Tennesseans 18 and over seriously consider suicide yearly 18,000 make suicide plans yearly 6,000 attempt suicide yearly 945 Tennesseans died by suicide in 2014

6. College Student Suicide Second leading cause of death for college students 1,100 college students die by suicide yearly 6.17 – 7.0 suicide deaths per 100,000 students 6% of undergraduates seriously consider suicide 92% of those have contemplated a suicide method or plan 14% of those who seriously considered suicide attempted suicide

7. What about Community Colleges? Not included in research samples Do not have large mental health departments Do not have student health services to assess and treat illnesses Students do not live on campus

8. Community College Students First generation students More ethnically and racially diverse than other students Work more hours while in college More likely to be from lower income families Less academically prepared for college level work

9. First Generation Students Twice as likely to attempt suicide than other students Less likely to report symptoms of depression Lack knowledge of academic culture Do not have family members who understand Might not be prepared for academic rigor Financially disadvantaged Work more while trying to take classes

10. Ethnically and Racially Diverse Additionally, first generation students are more likely to be ethnically and racially diverse A strong association between academic difficulties and suicidal ideations in diverse students African American college students have a slightly greater risk for suicide when compared to Caucasian college students

11. Lower Income or Financial Stressors Working more hours decreases time for studying 31% of students who seriously consider suicide cite financial problems as a contributing factor 78% of students who attempt suicide cite financial difficulties

12. Academics 100% of students who attempt suicide cite school-related stress as one of the reasons for their suicide attempt 43% of students who consider suicide cite academics as a contributing factor

13. Research questions What suicide prevention strategies exist at community colleges in the TBR system? – a. What educational strategies exist to prevent student suicide? – b. What technological strategies exist to prevent student suicide? – c. What institutional level strategies exist to prevent student suicide?

14. Purpose of the Study To explore the student suicide prevention strategies employed by the community colleges of the Tennessee Board of Regents system Qualitative case study approach Data collected from a survey, assessment of college web sites, and interviews with resource people Within-case and cross-case data analysis was performed through direct interpretation, categorical aggregation, and the creation of propositional generalizations

15. The purpose of data interpretation was to create an initial understanding of the suicide prevention efforts on the campuses Comparisons between the colleges and generalizations that were created were intended to provide a current picture of the issue being studied and were not intended to be judgmental in nature or to create a negative portrayal of any institution

16. Educational Strategies (of the 13 community colleges) Gatekeeper Training5 Curriculum Infusion7 Trained Peer Leaders1 Info distributed in newsletters7 Info on campus signage/posters5 Info at health fairs, events, brochures 6

17. Technological Strategies (of the 13 community colleges) Web sites4 Facebook page1 Online learning modules2 Web-based screening tools4 Suicide prevention hotline on web page 5

18. Exemplar Tech Strategies Online Behavioral Concern Form Online Anonymous Behavioral Concern Form (Silent Witness Form) Pop-up that had to be closed Psychological disabilities page for the Disability Services department in addition to a suicide prevention page Overall, however, tech strategies were sparsely used

19. Institution-wide Strategies Most interviewees stated they had a plan in place to address suicidal students secondary to “harm to self/others” in policies Only 6 addressed suicide in their policies (the S- word) Most were in East Tennessee Most were in small colleges No one had policies requiring the suicide prevention hotline on syllabi Five had post-intervention policies

20. Most had BIT Teams, but… Teams were created to prevent students from harming others “We have disciplinary policies that address disruptive students, but from a mental health lens, no.” “[We] don’t really have a plan in place that specifically addresses suicide.” “We have nothing, in my opinion, that addresses the best way to handle suicidal students. The policies are under disciplinary offenses.”

21. Overall… In most institutions there was no deliberate or organized educational effort to increased suicide awareness Technology was used sparsely across the institutions to provide suicide prevention info, to screen students, or provide referral info With only a few exceptions, the response teams were created to prevent campus violence and were not intended to help suicidal students Institutions that employed counselors (8) generally had more educational strategies, more suicide prevention strategies overall, and more policies that addressed suicide than those that did not

22. Overall… Most large urban institutions did not employ counselors; all 3 small rural institutions employed counselors Most larger colleges had fewer policies and fewer strategies overall (1 exception) Counselors were employed in all 6 East Tennessee Institutions Most of the institutions that had specific policies were located in East Tennessee All 6 institutions that had policies employed counselors

23. Lack of Resources Staff Funding Time Information Counselors Technical Support Uncomfortable Topic Competing Priorities Completion Sexual Violence Learning Support Technology

24. TSPN TSPN provided free resources, conducted training, and provided speakers for campus events “TSPN provides free brochures and they provide our information.” “TSPN is wonderful; they offer to go out and train people for free.” “The TPSN drives a lot of what we do.”

25. Internal Prompts Counselor and faculty expertise and passion Counselor experience Faculty interest Student welfare Student needs Student welfare efforts New programs and needs People on campus notice student behaviors External Prompts Virginia Tech incidentTBR policies

26. Suggestions Policies addressing with BIT teams Post-suicidal policies and protocols Policy recommendations from TBR Suicide prevention hotline number on course syllabi, possibly with a brief statement about the warning signs of suicide and campus contact numbers Counselors Suicide prevention training for employees and students Help students feel like they belong