September 7, 2023

*Reader Note: The following blog discusses the topic of suicide.

World Suicide Prevention Day was established in 2003 by the International Association for Suicide Prevention in conjunction with the World Health Organization. The theme for 2021-2023 has been “Creating Hope through Action,” emphasizing that through our actions we can encourage hope and strengthen efforts at preventing suicide.

According to the Centers for Disease Control and Prevention, 48,183 people died by suicide in the United States in 2021, which is about 1 person every 11 minutes. Suicide was the second leading cause of death for people aged 10-14 and 20-34. For those of us working in K-12 and Higher Education spaces, those age-related statistics are incredibly staggering and important for us to understand.

In our specific work in Title IX in K-12 and Higher Education spaces, we face a unique set of risks and responsibilities as it pertains to suicide prevention. According to RAINN, the likelihood that a person experiences suicidal or depressive thoughts increases after an experience of sexual violence. According to RAINN’s research, 33% of women who experience a rape contemplate suicide, with 13% making a suicide attempt. Children who experience sexual abuse or sexual violence are three times more likely to experience a major depressive episode as an adult which increases their risk of suicidal ideation.

Learning how to make good mental health referrals is critical to our work in Title IX when we facilitate supportive measures; however, the work of suicide prevention begins during our Title IX meetings with students and employees to notice and respond to any warning signs of suicide that might be present.  These warning signs can include:

• Talking about wanting to die or to be dead. (Sometimes this is less overt and sounds more like wishing it were “over” or that one could just stay asleep or that it would “end”.)
• Expressing hopelessness, guilt, or feeling like a burden to others.
• Talking about having no reason to live.
• Withdrawing from family, friends, responsibilities.
• Displaying extreme changes or swings in mood.
• Changes in eating and sleeping habits.
• Giving away items of significance.
• Increasing risk taking behaviors or substance use.
• Calling or visiting others to say goodbye.

If you notice any of these signs, overtly address them. It is a myth that asking about suicide makes someone more suicidal or that only a counselor can ask these types of questions. In fact, asking the question could very well save their life. While it may feel uncomfortable at first, the discomfort in asking the question is far more important than the risk in choosing not to. Here are some tips for how to ask this question:

• Start by sharing what you observed that led to your concern. For example, “I noticed while we were talking today that you seemed more distant and even talked about feeling hopeless and how you wish it would all end.”
• Follow this up with a direct question. “I am here to make sure you get the support you need, and that statement made me concerned today. I wanted to check in – are you having any suicidal thoughts, or have you had any in the past couple of weeks?”
• It is important to ask the question in a way that allows an honest answer by avoiding phrases like “You aren’t going to hurt yourself, are you?” or “I know you aren’t suicidal, but…”. These types of questions could lead someone to be ashamed or embarrassed to tell the truth.

While someone saying that they are having thoughts of suicide does not necessarily mean the person plans to act on those thoughts, finding them a mental health provider who can further assess that is critical. This is different from a typical Title IX supportive measure request where you and the party identify that they might benefit from ongoing counseling. The presence of suicidal thoughts should illicit an immediate referral to a school or university counselor and even possibly a broader crisis response protocol depending on the severity of the situation.

If the person shares with you that they are having thoughts of suicide, take the following next steps:

• Do not panic or show signs of distress. Instead thank that person for their honesty and explain that you need to loop in the counselor because you care for them and have a responsibility to keep them safe.
• Contact the counseling staff with this person in the room and develop a plan for the counselor to come assess further in your office or for you to walk that person to the counselor.
• If the person is resistant to this further evaluation, let them know that this is necessary based upon your concerns about their safety at this point and that you might have to contact for additional support if they choose to leave.

If the person’s response to your question about suicide is that they are not experiencing these thoughts at this time, take the following steps:

• Review supportive measure options for counseling to address the ongoing feelings and thoughts they are experiencing and make appropriate referrals.
• Remind them that you care and encourage them to let you know if those thoughts do show up at any point in the Title IX process.
• Provide them with proactive resources for suicide response in case they need them such as crisis call and text lines and the on-site counselor contact information.

I love this theme of World Suicide Prevention Day of creating hope through action. Instilling hope is everybody’s work, and hope can be displayed in so many ways to those who are hurting. Specifically, to the Title IX professionals on the ground, you show hope by noticing and by reminding those you are meeting with that you see them, you hear them, and their life matters enough for you to ask the question.

If you or someone you know is struggling with thoughts of suicide, you are not alone and help is available. Please contact the National Suicide and Crisis Lifeline by calling 988. You can also use the Crisis Text Line by texting HOME to 741741. For more resources visit 988lifeline.org or asfp.org.

This blog was written by ICS Title IX and Equity Specialist, Brittany Gates. Prior to joining the ICS team, Brittany was a licensed mental health provider for seven years with ten total years of direct mental health experience ranging from community based mental health care to a university counseling center setting.