With suicide attempts so prevalent, what are we doing about transitioning kids from psychiatric hospitals back to the school environment?
Transitioning kids back to school after a suicide attempt should be similar to integrating a child who had missed school for major surgery or cancer treatments. In other words, you treat that absence like you would any other major absence and follow the same policy you have for that transition.
The following is the ideal scenario, however, some rural and smaller schools don’t have these kinds of resources so follow what you can when you can.
Social and peer relations
Options:
- Connect the student with a school-based support group, peer helpers program, or a buddy/friend.
- If the culture at school has been difficult, arrange for a transfer to another school if recommended
- Remain sensitive to the need for discretion and how to minimize gossip
The transition from the hospital setting
Options:
- Have someone from the school visit the student in the hospital or at home prior to the re-entry process with permission from the parents/guardians
- Ask/Consult with the student to discuss what support he or she feels is needed to make a more successful transition. It’s important to make them feel like a partner in the process. Include what information faculty may need to facilitate a smooth re-entry.
- Request permission to attend treatment planning meetings and the hospital discharge meeting
- Arrange for the student to work on school assignments while in the hospital if appropriate
- Include the school counselor (or staff equivalent) in the school re-entry planning meeting.
Academic concerns on return to school
Options:
- Ask the student about his or her academic concerns and discuss the options
- Arrange tutoring from peers or teachers without putting too much pressure on the student
- Modify the schedule and adjust the course load to relieve stress
- Allow makeup work to be adjusted and extended without penalty
- Monitor the student’s progress and approach the subject with compassion
Medication:
Options:
- Alert the school nurse to find out information regarding prescribed medication and what the possible side effects might be
- Notify teachers if significant side effects are anticipated
- Follow the policy of having the school nurse monitor and dispense all medication taken by the student at school
Family concerns (fear, denial, guilt, social embarrassment, anxiety, lack of support)
Options:
- Schedule a family conference with designated school personnel or home-school coordinator to address concerns
- Include parents in the re-entry planning meeting
- Reinforce the fact that the information the school needs to assist the student is limited to facilitating optimal school adjustment and performance, and does not include personal details of emotional distress
- Refer the family to an outside community agency or private practitioners for family counseling services. (NAMI, AFSP, State and county agencies)
- Include information about community agencies with a sliding fee scale
Behavior and attendance problems
Options:
- Meet with teachers to help students anticipate appropriate limits and consequences of behavior
- Discuss concerns and options with the student in an empathetic manner
- Consult with discipline administrator
- Request daily attendance reports
- Schedule administrator and parent conferences to review attendance and discipline records
Ongoing support*
Options:
- Assign a school liaison to meet regularly with the student at established times. Try to assign someone who already has a relationship with the student and has empathy and compassion. Talk to the student about his or her adjustment.
- Maintain contact with the therapist and parents
- Ask the student to check in with the school counselor daily/weekly
- Utilize established support systems, student assistance teams, coaches, support groups, friends, clubs, and organizations.
- Schedule follow-up sessions with the school psychologist or home-school coordinator
- Provide information to families regarding available community resources when school is not in session
- Provide information for Family Members And Caregivers to get support (Mental health Family Members And Caregivers groups through NAMI for example)
Download the pdf. Source Hazelden Foundation Issues and Options Surrounding a Student’s Return to School Following a Suicide-related Absence by authors of Lifelines.
Download the pdf. Source HEARD Alliance Toolkit for Mental Health Promotion and Suicide Prevention (Worksheets and the exact page for re-entry is in the table of contents. Pdf pages 114, 151-156, 161)
No one thing is right for every child and then if there is re-entry to school, it takes planning to figure out what that should look like.
*In the event that a student loses a family member to suicide, school personnel should understand that suicide evokes special, complicated grief and most of the ongoing support considerations mentioned in Ongoing Support would also apply.
These articles provide good guides on what to do if a child goes back after losing someone to suicide:
- Returning to School After a Suicide Loss: For Teens
- Returning to School After a Suicide Loss: For Younger Children
Re-entry and other subjects related to prevention, intervention, and postvention are included in this book, Emotionally Naked, A Teachers’ Guide to Preventing Suicide, and Recognizing Students at Risk.
My 15 y/o daughter has struggled with anxiety for several years. And has asked me several times, starting in middle school, if she could home school. She just doesn’t like all the people and social aspect. I’ve always told her, she is going to have to deal with that situation most likely all her life. So avoiding isn’t the answer, she needs to find a way to make it work for her. She has not been very receptive of counseling, although she does like her counselor now.
So, jump to now. She has missed a month of school (since the beginning of the 2nd semester) due to a couple of things. She did have a medical issue for the first week, then it was anxiety and a week ago, a sucide attempt. She spent 4 days inpatient and is now doing intensive group 3 nights a week. Her teachers and counselor have been fantastic and are doing whatever they can to get her reintegrated. We had a meeting with the counselor yesterday and laid out a plan. She initially is going to the counselor’s office and working on catching up and can go back into the classroom whenever she feels ready. Even if it’s only a partial day in classes. Her teachers are to allow her to go to the counselor’s whenever she needs, etc. Again, they have all been fanastic. She has said that she wants to get back to the classroom.
She stayed in the counselor’s for 1 hour yesterday, after our meeting. I got a text after 20 minutes saying she wanted to come home. I did not let her. She went to school today and I told her she needed to work for at least 2 hours before texting me. It was exactly two hours. She has done all the catch up for one subject, so she is working. But wants to come home. Says all she is thinking about is that she doesn’t want to be there and if she weren’t alive she wouldn’t have to. She isn’t necessarily having a panic attack, but she is VERY jittery which is new. I don’t know if that is attributed to getting used to the new medications or not. The anxiety medication they put her on takes a couple weeks to build up.
so…
do I make her stay? I mean, ‘not wanting to’ isn’t really a reason. tons of people don’t want to go to work every day but they do. Then again, not all of them have attempted suicide.
should I reach out to a dr. to see if a short term anxiety med is the answer? if so, who? the inpatient dr.? the group dr. she will be seeing? She has not yet seen the one at group.
I’m really at a loss here. Any resources or advice would be greatly appreciated.
This is what I’m thinking. I’m not an LCSW or a school counselor so keep that in mind.
I’m wondering if you could empower her to be part of the plan to integrate back into the school population. Ask her does she think that avoiding it will really make her better? Ask her what she’d do instead? Let her answer. Don’t judge or otherwise lecture her on her point of view. Just listen and ask her questions and say, “I didn’t know that.” “Thank you for telling me that.” I think maybe you might discover her fears more by asking and just letting her talk. Do not criticize or counter her answers. LISTEN even if you’ve heard it a million times. That’s how she feels and doing so might invalidate her feelings. After you have PATIENTLY listened to her, ask her if she’ll listen to you without judgment as you did her. (you may have already done this.)
Start by saying the only option for school that is currently available is THIS school for the moment and you need her help to make it work at least until you are able to find an alternative. Tell her you want to work out a plan with her input. If she says one hour for the first week, let her have it. But work out a plan where she is also invested. Write it out on a piece of paper. And do a hug or shake afterwards. Make sure she has say in that plan no matter how crazy the suggestion. Then ask her how it all looks and thank her for working on it together.
There is also an option that if the counselors could get a sympathetic student, perhaps one who has been through this this, to check in with her. A friend who’s been this route. My son, Charles, did this at the school he went to and after he died that child wrote me and told me that by Charles being there for him saved his life in that vulnerable time when he returned. It’s called shadowing. She is not the only one at that school who has been through this. Trust me on that. The counselors would have to ask the student.
Peer to peer is very very powerful. It helps the person who is helping as well as the person currently struggling. That way she sees that someone like herself has integrated into the school environment. In the mean time, tell her you will look into “homebound school” but that might take a while to work out. And do that. Tell her it could take until the end of the school year. (set expectations so she’s not asking you daily.) See what is available in your area knowing you may not need it or you may need it only during periods she is especially stressed.
The more connected she feels, the more inner resilience she can build. Technology has resulted in 11–15 year olds having 45% less face time with friends. And I personally think that’s where all the anxiety is coming from. They need more face to face time with their friends not interrupted by digital devices. Kids need more lifeskills training as well. Schools are focusing on core subjects and have forgotten how much shop and home economics helped kids in terms of problem solving and working in groups. They need more scenarios and opportunities to work out problems. The schools are woefully lacking in this kind of education.
As you go through your own day and you ponder something, ask her how she might resolve it? (jot down on your phone memo when you think of an idea to share later with her) When possible try her suggestion. Give her practice problem solving my getting her input. Not just “What should I cook for dinner?” Some small dilemma and it can be logistics related. Maybe you are trying to figure out what size bed to get in the guest room and talk about all the benefits of a single versus a queen bed. That’s not a great example but maybe you get what I’m saying. Not really big grown up “I can’t pay this bill” issues. But smaller, bite sized issues where she can feel some success or learn from small failures.
Adolescents tend to think their feelings are permanent and take everything personally. No one single teen is thinking about someone else more than 5 minutes. More than 1 minute really. But when they obsess about something, they think others are obsessing about them. Not so. That’s just FYI and there are adults who think that, too.
Those are just some of my initial thoughts. Do come back and update. You may do something completely different. But no one in the country that I know of seems to have a good plan for this. I love this very short 32 page book. I use this with my older son. He’s 25 and I ask him questions and he works out an answer for himself. I’ve been doing this since he was 17. http://behavior-coach.com/EbookMotivatingVer3.pdf
When I was in high school and middle school, social media wasn’t really a thing yet and few people had cell phones. My first attempt was age 15. It was an easy transition back to school because not everyone knew why I had been gone or cared honestly. I had a few friends who missed me and I confided in them why I had been gone. Of course at that age who knows what to say to one another about suicide? A few years later it happened again. This time wasn’t as easy. A “friend” of mine thought it was best to share with my counselor at school what was going on in my personal life. Although school was alot less stressful after that. I felt like the entire staff was walking on egg shells. It was strange and I got to leave class whenever the teacher thought I was too stressed or angry. I was left to wander the halls or go to the computer lab for the rest of the class period. A situation like that can be helpful but it can also be damaging to young minds. I didn’t learn much of anything that way. I learned that if I raised my voice or appeared angry in anyway I could just slip out of class and not have to worry with education. Not the best way to go. I made it through and have attempted suicide in my adult life. Looking back confidentiality is key. I’d suggest addressing staff in a delicate manner. Of course we don’t want stress on someone who is just returning and is naturally overwhelmed but at the same time I think it’s important to let them know you care and sometimes that means being a little stern when it’s called for, we don’t want them slipping through the cracks. And wearing kid gloves is one of the easiest ways to do that.
Thank you for that. Mystie. Your perspective is so important and this is very helpful. If you want to write a post about this as a blog post, your lived experience, let me know. You can use just a first name or be completely anonymous. https://annemoss.com/contact-2/submit-a-story/