I want to welcome all of you to this to this webinar on behalf of the substance abuse and mental health services administration in just a moment I’ll turn this over to dr. Victor Schwartz from the JED foundation who Samsa is very pleased to be able to co-sponsor this webinar a width and he will be facilitating the webinar for us I just wanted to say a few words about the importance of the issue we’re going to be speaking about today everyone listening I’m sure is aware that the topic of suicide arouses anxiety in most people including clinicians such as myself because none of us want to make a mistake when someone’s life is at stake this anxiety is even magnified when a suicide cluster appears to be emerging at these times the anxiety can be palpable and pervasive and the need for solid base and prudent information is vital at such times it is precisely because we don’t have all the answers about how to prevent suicide clusters from happening that it is essential that we work together to share what we do know including learning from the experiences of those in communities and tribes during college campuses who have gone through this intense and difficult experience so that we all might learn and move forward together so again on behalf of Samsa thank you for signing up to this webinar and we think it will be a very beneficial one for you to be participating in and with that I would like to introduce my colleague dr victor schwartz from the JED foundation thanks so much Richard it’s a pleasure to be here with you when I really hang all of you with Samsa you Richard and your team and especially Jennifer Capello who’s done a tremendous amount of the work setting up this webinar and getting things organized from really working along with us to get an incredible group of speakers to be here with you today to really creating the platform and the structure for this webinar so thanks to you and to your whole team at Samsa for the work you do and you know for partnering with us in working with the 20 million or so college and university students in the United States so just a couple of words of introduction and we know that some people are having some challenges logging in so we’ll try to take a little bit of time and that’s why just an apology that we started a bit late just to give people who are having some difficulties a chance to join us but just a few comments about the agenda for the day we have really two sections to the program the first will run until approximately three o’clock or so and then we’ll have a 20 to 30 minute break depending on how on time we continue to be and then run again from 3 30 25 as you see the first section of this webinar will be an overview of the epidemiology the demographics really what we know from a theoretical perspective about suicide clusters in general what we know about the epidemiology and demographics of clusters on college campuses and then we’ll have a presentation about safe messaging and the media concerns around suicide and suicide clusters and again particular comments or around the setting for campus as you see our first lineup of presenters are dr Madeline Gould who is a professor of Epidemiology in psychiatry at Columbia University and the new york state psychiatric institute a good friend of Sam’s and the JED foundation and a real leader in the field of suicide and suicide prevention particularly in relation to young people and our good friend Carrie Smith from the suicide prevention Resource Center she’ll be telling you a bit about that she is senior campus prevention specialist at sprc and works closely with the schools who are in the Garrett Lee Smith grant program which I think she may be talking

about a little bit and just to give you a sense of the lineup after Matty and carried do their presentations we are going to have our second half of the afternoon presenters join us and I’ll introduce them in more detail but this dr. Delores meanie dr. greg eels and dr Phil mile Minh they’ll be joining us for a 20 to 25 minute panel discussion among the presenters and then we’ll be leaving hopefully 20 to 30 minutes for Q&A from the audience so the Q&A process is going to be all because of the size of the audience we’re going to be doing all of the QA through the website if all of you would notice at the top of your screen there is a an option that says QA if you click on that and type your question and then you can either click ask or enter you’ll be able to submit your question we obviously won’t be able to get all of the questions answered since we have quite a large audience today but we’ll try to cover many as we can and I see actually we have a question about accessing the powerpoints so just a reminder we will be posting a audio and the power points from this presentation on the SPR see Samson and Jed foundation websites after the closed captioning is completed so again the webinar contents will be accessible to anybody who wants to hear this down the road they’ll be on the three websites and potentially other places too we were not sure so again just a reminder the proceedings are being recorded when people post questions and we use them we’re not going to be identifying the questioners just for everybody’s privacy and with that I think we’d like to begin and as I mentioned our first speaker will be dr Madeline Gould who will be giving us really a kind of theoretical overview of suicide clusters and what we know specifically about how and why suicide clusters occur on campus so I’ll now turn it over to Maddie Thanks okay thanks I’m delighted to be part of this webinar today and welcome to everyone and today what I’ll briefly start with is providing you with information on the scope of the problem the D estimated rates of college suicides and then most of my presentation will focus on me as just mentioned theoretical but largely the empirical evidence for suicide contagion as well suicide is can t the second leading cause of death among college students which I think much of the lay public isn’t aware of how you know the extent to which young students died by suicide and those rates of completed suicide range the between six and a half to seven and a half per hundred thousand this translates to about fifteen hundred young people on college campuses dying per year assuming that there are 20 to 21 million students in college that’s not hasten rate of a matched cohort from the general population so this is a very serious problem among college students the the rates of dying by suicide are actually even higher among young people same age who are not in college when you look at attempted suicides about 1% of undergraduates have reported that they’ve attempted suicide and between six and nine percent report that they’ve seriously considered suicide in the past year now there are limitations to these estimates because college student suicide rates are not officially tracked by the Centers for Disease Control on a national level or from you know the state departments of health and who keep the statistics so that because they’re not officially track these estimate the rates the available rates are just estimates they’re based on some very good studies but nevertheless their estimates in so that there is no

national data firm data that’s available on the numbers or rates of suicide clusters for certain because without the data on the rates of suicide generally there’s no way to be able to identify whether clusters are occurring on colleges and university campuses so what we know about that is usually from anecdotal reports and that we can get a lot of useful information and the folks will be talking later on in this webinar based on their experiences on how they had to cope with a cluster you have given us very very valuable information but on a nation white faces there’s no information available on suicide clusters and so that gives you know the major challenge then to do research on suicide clusters on college on you know in college population I’ll start with on the definition of suicide contagion or sometimes called modeling and it’s the process by which knowledge of one suicide and that knowledge can be direct that someone actually knew that person died by suicide or it can be indirect I can be through on word of mouth or it can be through on media but that that knowledge facilitates the occurrence of another suicide and that there are several mechanisms that have been hypothesized to to be the basis for suicide contagion remodeling these are not mutually exclusive they probably do work together I’m not going to be going into much detail about any one of them if folks have questions you know write them in and we can we can discuss it but they range the mechanisms range from social learning theory which has been very well established over but so many different behaviors bandura was the first person from to have been describing that and I won’t read through you can read the slides but I do want to just highlight the last one just a little bit the emotional contagion which is our ability to empathize with others and that can make us prone than to mimicking or adopting other people’s behavior or even confusing other people’s emotions with our own the reason that I wanted to just highlight that a little bit and not to say that that’s the most important but there was a very interesting example on that of emotional contagion by the you know it’s been called is now Facebook newsfeed experiment which um became quite infamous in when it was published in 2014 because of different you know consent issues that people were about but that can be another question as well for now I just wanted to mention that for one week that was in January of 2012 Facebook actually altered the number of positive and negative posts and news feeds to nearly 700,000 randomly selected users to see if it affected their behavior with regard to the tones of their posts that they then would subsequently send and it turned out that the people who saw more positive posts responded by writing more positive posts and those who saw a more negative or content wrote on post that had more negative content and it showed in a very very graphic way that emotions can be spread on social media that was published in the National Academy of Sciences the Proceedings of the National Academy of Sciences for those who want to find that but many of you I’m sure write about it in the popular press and so with regard to empirical evidence for suicide contagion or modeling it comes from three areas the impact of studies that have examined the impact of exposure to a suicidal peer research on the impact of the media and research on suicide clusters and that’s what I’ll be describing so this is a summary slide of those studies that have examined the impact of exposure to a suicidal appear there about 20 or so studies now they’ve looked at the association between suicide attempts or deaths but most of them have focused on suicide attempts by a peer and then subsequent behaviors among friends and that the majority of the studies have found a significant association Oh or stands for something is called an odds ratio it’s a very

similar to what’s called a relative risk but in the measure of increased risk so that if someone’s someone in the peer group has attempted ride or die by suicide there is a three to 11 fold increase in the odds that this you know friend will actually attempt suicide so that clearly the impact of someone else in your either social network or a larger community but by appear similar age will increase an individual’s risk of of attempting suicide again you know I’m going to be going quickly through much of this empirical evidence so again you know I welcome questions after our presentations the research tab has examined the impact of the media there’s many more studies that have looked at this now you know now probably up to about 70 studies and that the research finds that there is a significant association that you will get a greater increase in suicide under these conditions when the frequency of the stories increase so there’s clear of it into the dose-response effect the more stories that are reported on about suicide the greater the likelihood that they’ll be subsequent suicides and I’m talking about completed suicides now the higher proportion of the population has exposed the greater increase in suicide if the headlines are dramatic if the stories are prominent for example if they’re on the front page and these are the research has focused on stories that have covered non-fictional on deaths there’s a little more critical evidence from stories that have focused on fictional a fictional stories or stories about you know not real people but the evidence from reports about people who real people who’ve died by suicide it’s really concluded it’s very consistent it’s conclusive in that conclusion that you will get some went on you know completed suicides under the conditions that are apt to influence somebody else’s behavior I’ll be talking about the types of stories that might not have that negative effect in just a moment in addition to finding an increased emphasis sides there’s also evidence that you can find a decrease in certain situations in these converse effects so there have been studies that have reported a decrease in suicides following the release of media on recommendations or guidelines or during these paper strikes in that what has become a very influential study now is the study that has coined the term Papageno effect whereby there’s a decrease in suicide following articles on suicidal individuals who’ve adopted positive coping strategies and actually have refrained from suicidal behavior in adverse circumstances so there had been something that had been coined as the Werther effect and those were the studies that I reported on in or summarized in my past slide where why you get an increase in suicide following suicide stories as the Werther effect and that was um based on the Sorrows of Young Werther that was written by Goethe in that after that publication you know there were a whole slew of people who were mimicking that death but in contrast now on there’s something that’s it is this Papageno effect and it’s based on the work by Thomas needa proton’s all rvs at the University of Vienna and I have the good fortune of collaborating with on a few different studies he published this work one of many nails studies that he’s published in 2010 which was a Content analysis of nearly 500 suicide-related print media reports that were published in Austria in there 11 largest nationwide newspapers and um he had anticipated that he would find an increase in on suicides in the you know communities that had access to the newspaper stories and he did find that and if the story if

the stories were repeated and under certain circumstances but what he also found was in those studies with the person that the article was about instead of succumbing to suicidal behavior actually adopted you know helpful coping strategies in light of their suicidal behavior that in the communities that then where these stories were published there was a significant decrease in the rates of completed suicide so on thomas i had coined the term Papageno effects based on an opera by Mozart The Magic Flute where the no character instead of succumbing to suicide on you know you know these in fairies and various things you know give him strategies to say no don’t die by suicide and he indeed doesn’t go on to on engage in suicidal behavior and that’s where the term now has gained a lot of speed in this next slide I want to show you how the evidence of the least in Vienna they have called it media guidelines in the US we talked about really media recommendations that Kerry is going to be elaborating on and you can see that there was a very very dramatic decrease in rates in the number of suicides these were some suicides that occurred in to the in a subway system because that was the most prevalent means of dying by suicide in Vienna and the media guidelines specifically on targeted subway system suicides and there is a seventy-five percent decrease the publication and the dissemination of these media recommendations I now want to move on to the evidence that we have about suicide clusters and the other speakers you know later on we’ll discuss their experiences that they’ve had on their college campuses with how they had to cope with suicide clusters and this headline unfortunately very dramatic headline not something that we would have recommended of being reported in this way but very dramatically defines what we mean by a suicide cluster here was a sex than a string of missed a fatal flaws and that on the definition you can also see unfortunately that they’ve included in this article the actual names of the young people who died by suicide and how they died by suicide what we mean by a suicide cluster is an excessive number of suicides occurring in a close time in close time proximity and your closed space proximity and that there have been a number of different studies what I’ve called the first generation second generation and third generation or on what started off with descriptive anecdotal reports and just sort of descriptions of you know what is this what’s going on here and then another series of studies that have asked is it really a cluster does it meet criteria for being a statistical um you know significant statistically occurring cluster and then a third generation not many studies but of trying to examine why why are they occurring and so I won’t list all the anecdotal reports that have been reported but i do want to we summarize some of our own work that looked at you know our suicide clusters occurring on to the extent that it’s actually statistically significant and I won’t go into all the Steve I will say that you know we looked at suicides across the age span and I just want you to focus on the highlighted conclusion that clusters occur primarily among teenagers and young adults that when you look at other ages they may sporadically occur but not at it not at a rate that would be considered on you know a public health problem or at you know what above what you might expect by chance but long teenagers and young adults it is a public health problem and it is occurring beyond what you would expect by chance and so in a psychological autopsy study that we did of cluster suicides and adolescents that was funded by the national institute of mental health as well as the american foundation for suicide prevention we wanted to examine well why is it that

you can get suicides in in in this case it was actually 53 communities and so you get a suicide in in a community and then there are other young people who died by suicide following that first suicide but in other communities on where suicide occurs you don’t get additional suicide in so we identified 53 clusters in the u.s. there were certain states out west that didn’t agree to unpartitioned which is why some of them don’t have clusters listed on my listed online app and that the definition that we used was a significant excess of suicides found specifically that it was within a town or city of residence or occurrence on so that you know we know that some college students you know they died in a place that’s not their official residence if they are you know in school and their official residence is that their parents these are for our study it had to be in a significant excess within a three-month period and it was limited to communities less than 500,000 which at that point was just New York go and Los Angeles the statistical reasons again if you have questions we can talk about it but I do want to emphasize that for practical purposes this is not a definition i would use or a study it’s fine but in work that I had done with the CDC um you know back in in the early 1990s our definition of a cluster was if the community thinks it’s a cluster than for all intents and purposes they you know public health and mental health professionals have to react as if it is a cluster but for research you have to have a more rigorous definition in that our clusters ranged in size from 32 all the way up to you know actually 11 um you know we had a match sample of controls be were these were all so young people who died by suicide because we wanted to know why as I mentioned before do you have a death by suicide that doesn’t lead to a cluster yet another death by suicide that does so that they were matched on the date of death and so on they had been in the same state the population sizes were similar they had to be to Sesame a which is whether or not they were in a metropolitan area they have to be within the same age range um and that we received you know we did a psychological autopsy by on interviewing parents and peers getting coroner’s reports police records census data today I’m going to focus on the information that we’ve published on our newspaper review that was published last year in Lancet psychiatry and it specifically was addressing the question does the media play a role in triggering a cluster um and so it was a national population-based sample of clusters we had again as I mentioned the match sample of non close to suicides and communities very very comprehensive identification of newspapers in each community we had conducted content analyses of you know over 1,700 stories that occurred in these communities looked at a number of confounding factors I’m just going to briefly summarize the the results so that we can get to the the remaining speakers as well that in comparing the stories that occurred between the first person who died in a cluster and the second death so that point at which a suicide started to be initiated and taking that stainless in length of time if there was within 10 days between the first on young person to die in a cluster and the second to die in the cluster then we would take 10 days for that matched community and look at 10 days worth of newspaper stories if there had been three weeks or four weeks between a first um death and a subsequent death then we would take that length of time in the match community if there were two days and we’d look at two days and on what we found by doing a content analyses of all those stories is that there was a significant increase in the number of stories following and the first person to die in what then became a suicide cluster so if you get that first death by suicide and you have a lot of students ID stories about any suicidal individual then it’s more apt to then trigger a suicide cluster we also found it you know to get significant number of stories about that actual first suicide and other teen

suicides as well and that would increase the likelihood of a suicide being triggered the characteristics of the stories that were associated with the triggering of a suicide cluster was on a story being on the front page the size of the headlines being bigger on the headlight there were more stories with headlines containing the word suicide and that’s going to come up in some other people’s presentations you’d have more stories with headlines containing description of the methods that those are going to be coming up again on more sensational headlines more pictures and more details scriptions of suicidal individual and the you know the actual act of suicide so that there were clear on characteristics of the stories that were associated with the triggering of the of suicide clusters so I just have a couple of more slides and then I’ll be done I just wanted to summarize the magnitude of the effect and I’m saying that there is a significant effect again i want to say well how big effect is that we know that from those the research studies that i summarized with regard to the exposure of dudes that appear that the increased risk seems to go from three to about 11 times you know greater odds of engaging in attempted suicide if you’ve been exposed that just to give you an idea of the impact of the media there was a twelve percent increase in suicides following you know shortly following Marilyn Monroe’s death we saw that seventy five percent decrease in subway suicides following the implementation of media guidelines and that with regard to suicide clusters again I want to emphasize there’s no national data but then really some of the work that we’ve done to give you estimates of of suicide clusters but our best estimates is that it’s actually relatively rare as between you know one and five percent of teen suicides this doesn’t include college-aged suicide so that you probably would be doubling these rates if you included them I just want to UM end well actually here in the MOOC sorry on last life but just to put suicide clusters in in context of really many of the many risk factors that influence suicidal behavior that you know suicidal behavior doesn’t occur in a vacuum there has to be some underlying vulnerability these are from psychological autopsy studies and many other or you know other types of studies um you know stress event occurs that exasperates some underlying vulnerability or sometimes the underlying problem may cause the stress event if someone is you know irritable on that causes acute blue change and that’s where now on contagion in the media can play a role in that once you have a recent example either again direct or indirectly it may facilitate this very vulnerable person um you know engaging in suicidal behavior but luckily with media models of coping that young person won’t engage in suicidal behavior so now I really am ending and so in conclusion that given the prevalence of suicide on college campuses and the associated risk of contagion and clustering that we know is real that is imperative that colleges develop effective and comprehensive postvention strategies and luckily many of our you know the speakers today we’ll be talking about the post vention strategies that they put in place so thank you for taking the time to listen and now I’ll you know move on to Carrie Smith thanks so much matty odd that was a really great overview of the theoretical concerns around suicide and suicide clusters and contagion we’re now going to move on to carrie smith who as i mentioned before as a senior campus prevention specialist at the suicide prevention Resource Center who works with many many colleges around their suicide prevention and mental health programming Carrie is going to go into more detail but of some of the things that Maddie covered in discussing really what what should we be doing and not doing around recording and media coverage of suicides and suicidal behavior so I’ll now turn the presentation over to Carrie Smith great thanks Vic I also wanted to echo Maddy thank you for doing such a wonderful job of laying out the issue of suicide

clusters and suicide contagion so I’m really delighted to be joining you all today so for those of you who aren’t familiar with sprc we are were established in 2002 and are funded federally through Samsa sprc provides prevention support and serves as a resource destination for anyone who’s looking to find out more about suicide prevention and as Vic mentioned my primary role is to provide training and technical assistance to colleges and universities that have gotten Garrett Lee Smith suicide prevention funding through Sam sub but we also provide assistance to a wide range of populations from other campuses local community organizations statewide agencies and tribal nations in the interest of time I won’t go over all of the resources we have available but after today’s webinar I hope you’ll take a few moments to take a look at our website sprc org and explore some of the resources we have including a searchable online library free online courses and a portion of our website that’s dedicated to campus suicide prevention I also did want to mention that sprc serves as the secretariat to the National Action Alliance for suicide prevention which is a public-private partnership that’s dedicated to advancing the national strategy for suicide prevention I wanted to highlight this because we’re going to be spending a little bit of time today discussing a resource that was developed by the Action Alliance so when my portion of today’s webinar will spend a little bit more time examining the issue of how we communicate about suicide deaths and stuff you can commit can take to communicate safely and effectively in the event of a death on your campus I’m also going to spend a little bit of time talking about how you can work with the media both on and off campus to ensure that news about the deaths or deaths is reported in as safe and as helpful of a way as you can manage and then I’ll also talk a little bit about how to address communications over social media platforms I should note here that Communications is just one part of an overall comprehensive postvention response after a suicide death and my other colleagues that are on the webinar especially those in part two will be able to cover some of those other considerations and as Victor mentioned we also will have some time after my presentation to answer any questions you have so please feel free to type in your questions in that Q&A tab at the top of your screen and we’ll get to those after my presentation so as Maddie mentioned she’s a really great job of laying out the research of how the media can influence suicide contagion what I’m betting that most of you are not from the media so I think it’s important to first point out here that saved messaging concerns are not focused solely on the media how we in the suicide prevention field campus administrators and other campus staff communicate about suicide could also potentially influence those who are at increased risk of suicide it’s also equally important to recognize that using unsafe messages or focusing too heavily on how big of a problem suicide is can undermine our prevention efforts by reinforcing stereotypes or making it seem like suicide is too big of a problem for us to solve so how do we communicate safely about suicide the National Action Alliance for suicide prevention created a comprehensive resource to help guide suicide prevention communications planning the framework for successful messaging can be used to help develop any communications about suicide not just communications about a suicide death this slide includes an image of that framework model and as you can see safety is one of those main four components and I’ve also included a link to the framework on this slide so that you have it okay so let’s dive a little bit deeper into the guidelines about talking safely about suicide so here is a list of the don’ts for messaging that are outlined in the framework and these guidelines are meant for anyone who’s going to be communicating publicly about suicide and as Maddie mentioned there are guidelines specifically meant for the media and we’re going to talk about those a little bit later in the presentation so let’s walk through these guidelines when communicating about suicide we want to avoid showing or explicitly describing suicide methods or locations where someone has died by suicide as Maddie mentioned pictures or detailed descriptions of how or where a person died by suicide can encourage imitation and serve as a how-to guide we also want to avoid including personal details of

people who who have died by suicide vulnerable individuals may identify with personal details of someone who died by suicide which could encourage them to end their own lives as well we also don’t want to glorify or romanticize suicide portraying suicide as heroic or romantic or honorable acts may encourage vulnerable people to view it more positively and lead them to also seek out the attention garnered by someone who is died by suicide and a common issue that you’ll often see in news articles or other communications materials about suicide is it being normalized or portrayed as a common occurrence so when we’re communicating about suicide we want to walk a fine balance of not minimizing the problem of suicide but also at the same time we don’t want to apply imply that suicidal behavior is acceptable normal or what most people would do in a given circumstance I think we all know that the vast majority of people who face adversity live with mental illness or face other challenges even those in high risk groups do not die by suicide and instead find the support and treatment and other ways to cope and as Maddie mentioned with the media resource these are really the messages that we want to focus on instead and similarly we don’t want to use data or language that suggests suicide is inevitable or unsolvable so describing suicide as an epidemic or using terms like fullest bully side which could imply that someone who is bullied will inevitably attempted suicide may make suicide seem too overwhelming to a dress and along these lines we want to avoid providing extensive statistics about suicide to the public without at least also including solutions or action steps that reinforce that suicide is preventable in addition to this week we want to make sure that we don’t portray suicide as being an overly common or unsolvable of then we also want to avoid oversimplifying the causes of suicide so we know that suicide is complex and it often as a result of a variety of risk factors so therefore we should avoid attributing suicide to a single cause or circumstance such as a breakup or bullying high stress at school or being from a particular high risk population and we should also avoid portraying suicide as having no cause whatsoever so in this case we mean describing suicide is an inexplicable act from an otherwise healthy or high achieving person because this may encourage identification with that person who died or again conveys that suicide is something that can’t be prevented and more importantly also this language is a missed opportunity to educate the public about warning signs and how we can respond to them and lastly we should avoid reinforcing negative stereotypes myths or stigma related to mental illness or suicide this sometimes can feel like it’s easier said than done but we’ll talk about how you can kind of avoid some of that so some examples of this is messages that link particular groups with high rates of suicide or mental illness especially without examples of effective interventions or stories of recovery so an example of this would be focusing heavily on talking about suicide in veterans in a way that makes it seem that all veterans will attempt suicide also making broad statements such as breaking the stigma of mental illness or other similar language that reiterates the extent to which stigma is a problem this actually can serve reinforced stigma rather than counteracted and lastly using adjectives like successful suicide unsuccessful suicide and failed attempt can make it seem like a suicide death is defined as a success and that a non-fatal attempt is a failure additionally terms such as committed suicide are also problematic because the term committed is often associated with crimes so using this language can reinforce stigmatizing attitudes about people who die by suicide so instead it’s better to use language such as died by suicide or completed suicide so to illustrate some of these safe messaging don’t let’s go through some mock newspaper headlines and see what you feel might be unsafe so I just made up these headlines but I’m sure you all have seen similar headlines before so just take one moment and look at these and consider what may be unsafe

here so the first headline I think probably after Maddie’s discussion you might recognize what’s not okay here this is it’s explicit discussion of mean so that could influence those to also try that particular means of suicide that second headline where it states gay college student bullied to death that phrase bullied to death oversimplifies the reasons why someone may attempt suicide and as we talked about suicide is complex and saying one thing is to blame for their death really ignores the constellation of risk factors that likely influence their decision to attempt suicide and then that last headline university president working to stop suicide epidemic on campus using the word epidemic on canvas can make it seem like a common event that we may not have a solution to and as we talked about just a moment ago focusing on how big the problem of suicide is also misses the opportunity to share those stories of hope recovery and resilience and how people can help those who are struggling with suicide that the research that Maddie mentioned shows can actually be protective so in one of these examples our media headlines I’m sure you can see how some of the language can creep into our prevention messages and communications after a suicide death so you’re probably wondering after saying is long list of don’ts how you should talk about suicide especially after you experienced a death on campus and I wanted to show you some real examples of how we can communicate safely about suicide and mental health in a positive way and these are headlines that aren’t specifically related to post vention but I think it’s helpful to see that compelling new stories can be created without unsafe or sensationalized language and that also holds true for our prevention communications and many safety issues occur when messages focus on the problem of suicide rather than what can be done about it so the framework for successful messaging includes the section on conveying a positive narrative about suicide which in essence is just shifting our communications away from the problem of suicide and instead conveying concrete steps people can take to help themselves or others at risk for suicide while also highlighting effective treatments and stories of recovery so I wanted to switch gears here after we’ve gone over those do’s and don’ts and talk a little bit about planning steps you can take now so that you can maximize your communications if a suicide death or deaths occur on your campus it’s always helpful to develop your post vention response prior to a death because I think we all can attest that it’s much more difficult to do good strategic work in the middle of a crisis and also dealing with multiple suicide deaths I think it’s especially important to be able to move quickly and provide clear accurate and supportive information as quickly as possible before rumors and inaccurate reports of events start to circulate so one of the major areas are going to want to think about is the policies that you should have in place around communications about the suicide death or death if one was to occur so this slide includes a few questions that are helpful to think through often it makes sense to identify one person whether that’s your Dean of Students your VP of Student Affairs your college president or some other person to communicate about the desk to the campus community you will also want to identify the best method to do this whether this is in an email or of some other form of communication and if you’re part of a large University you may also want to decide if that announcement should go to the entire university or just the school or college that the student was enrolled in we’ve seen that some schools also decide to send separate announcements to faculty and staff that give guidance on how to respond to students who may request extensions on projects or have absences to attend memorial services as well as resources for reslife staff for how to talk about the death with students living in the residence hall in addition to that broad announcement you may also want to consider having your Dean of Students Counseling Center Director or representative that you identified for that campus-wide communication to also provide a more personal maybe even face-to-face announcement with friends or close classmates of that to see student it’s also good to spend a little bit of time thinking about the actual content that would be shared within these announcements so the information that

will be included will likely be influenced by what is known about the dust the family’s wishes in the time of year or so if the death happens during the summer or some other break it might look different but it is still helpful to create a template ahead of time that can be used in the event of a death and then it can just be tailored to the situation so this will allow you to also get information out more quickly and thoughtfully and hema the higher ed Mental Health Alliance created a really great post vention guide that’s included in the resources for this webinar that includes a sample general announcement letter that you can work off of and again while the information shared will vary by situation you’ll want to at least include condolences to family and friends a description of what the school will be doing to support those grieving the loss and any changes to class or work schedules if applicable and I think my colleagues on this webinar can share some of their thoughts about addressing family wishes later on but if the family does not want to publicly acknowledge the death a good first step is to explain to them why it’s helpful to share that it was a suicide death so by letting them know that you can better address the needs of friends and other students who might be impacted by the death or be potentially at risk as Maddie’s research showed and there’s also likely rumors already swirling around and this will help you provide more accurate information and kind of get ahead of those rumors if they still don’t want the information shared it’s probably best to announce it as the sudden death and frame any mention of resources available as grief resources that you would offer in during any death there’s probably already as we said speculation that the death was a suicide so you can certainly consider including suicide prevention resources and talk about suicide with students as part of your overall grief resources so you don’t have to completely avoid the topic of suicide if the family is unwilling to publicly announce that you’re also going to want to work through who will be designated to talk with the media often this would be someone out of your public relations or media office as well as possibly select senior administrators or Counseling Center leadership and all of these folks who are designated contacts should be briefed on sample talking points and the safe messaging guidelines that we just talked about so I think we’ve already established that working with the media can be challenging sometimes especially in the wake of several suicide deaths and I know that Dolores and others on the webinar can share some of their experiences with the media overstepping their bounds or writing sensationalized unsafe stories so this is why it’s especially important to come up with policies and protocols ahead of time that designate specific media contacts after suicide and you’re really going to want to stick to those protocols that you you determine when a crisis occurs so while you can’t choose which reporter is going to write a story about your school it can help to establish relationships with your local newspaper and any reporters who focus specifically on health or mental health reporting this also goes for on-campus media as well and once you establish those relationships with your local news outlets it can help to also provide informational packets to reporters that include the segment reporting guidelines resources for suicide survivors sample language to include at the end of any mental health stories that includes the National Suicide Prevention lifeline number and information about your mental health promotion and suicide prevention efforts doing this before a crisis occurs one will hopefully get them to focus a bit more on what you’re going to be doing to respond to the suicide death or death but it may even prompt them to write a positive story about your work before a suicide crisis occurs and you also will want to be prepared to respond if someone from the media reports on a suicide in a way that’s not safe so this may mean contacting the reporter to let them know what was unsafe about their story or even writing an op-ed or letter to the editor to help reframe the issue especially for student reporters your guidance on how to help reduce the risk of contagion can provide a really valuable learning experience that I personally hope that they’ll carry on for their future reporting when they’re out in the field and I’ve also heard of several schools where mental health promotion staff have established relationships with their communication schools so that

munication students receive training unsafe reporting in their classes so that they’re getting that information before they hit the ground so we’ve talked a lot about those reporting guidelines for reporters this is a link and screenshot of the recommendations for reporting on suicide for the media this was a consensus document that was created in conjunction with sprc Samsa and several other organizations and it provides just a nice to sink to page list of do’s and don’ts that you can provide the media or student media to hopefully help them create safer stories and also I don’t think I have to tell you all that social media plays a large role in the lives of college students information can travel really quickly on Instagram Facebook Twitter and all the other platforms that it’s often hard to keep track of which ones are so popular now so it’s really helpful to have a plan in place ahead of time for how you want to include social media in your post vention response so this may mean posting information about services available monitoring to see if comments are made indicate a need for outreach to particular students and also combating any of the unsafe messaging you might see in posts and oftentimes students will have privacy settings that may prevent you from seeing information on their pages so you’ll need to work with friends and families to monitor the deceased students page or to look out on other pages to see if something is unsaved and also several media platforms including instagram facebook and twitter now have guidelines in place for reporting concerning content so you may want to familiarize yourself with this process and educate others who may be monitoring the pages so I know it can be it can seem daunting to include social media in your post mention planning but are some resources out there for you the National Suicide Prevention lifeline has a really great online postvention manual that includes sample language that you can use for posts and responding to concerning posts all of these are included in the resources for this webinar also it on this slide you can see the information that Facebook provides for how to respond to a friend that you’re concerned about or how to report concerning content and then of the JED foundation Facebook Instagram and the clinton foundation created a really great guide for teens or young adults for what to look out for in terms of concerning content from their peers and how that you can respond to that so there’s also those resources that you can rely on as well and with that I am going to conclude my part of the presentation and I look forward to hearing questions from you all thanks so much carry that was a very thorough and clearer view of the subject of media and social media and reporting around suicide and safe messaging so we are now at about 235 and we did get started a bit late but just as a reminder to those of you who are listening in what we’re going to do now is ask the presenters from part two of this presentation to just make a couple of comments and responses and thoughts and maybe get a about a ten-minute conversation going on and then hopefully leave ourselves about 15 minutes or so I suppose we can probably run till about 30 5 or 310 with QA just as a reminder if you’d like to post a question I see some of you have been posting questions into the question box go up to the QA bar on the top of the page enter you you the contents of your question and either press ENTER on your keyboard or ask the Q&A box and we will hopefully get to as many of your questions as we can but now I’d like to ask the loris Greg and Phil to respond and share any thoughts or comments they might have had in response to the first section of our presentation I’ll start of this is greg from cordele yeah i would just say that everything that has been talked about is just a great foundational kind of guideline for when you have a type of clusters on our campus but we were fortunate enough when we had a series of six suicides within a single year and have Madeline with two other colleagues

air cane and Carrie knocks come and talk to us about some of these issues and you know one of the things that really hasn’t come up around this around clusters is around the intersection which all talk more about it in my part of the presentation but i thinks the the method of the completed suicides also really changes how you have to talk about some of these things and I think I really is a challenging issue and even though there are broad general guidelines that we scary said we need to think out each one of these is going to be different there are going to be a lot of different ways in which it impacts the community in kind of a high-profile visible Dex awesome that we’ve had a Cornell some that like the one that’s been picked up in the media at Penn from parking garages they do impact the community differently and have a way of impacting how you how clusters can develop and I think of some unique ways that really require you respond Dolores or fill their arms all chime in at this point this is Delores termine from the University at Albany and I would also concur that the information that’s provided on this webinar really resonates with our particular experience at the University at Albany on part 2 you’ll hear about the cluster suicides that we experienced in 2011 in the spring and one of the things that really came to light for us is even though they’re very clear guidelines and lots of resources to help us every single suicide that can occur in a cluster or student desk for that matter even if it’s not by suicide exist in a context and it’s really important to look at the system how the student body reacts what the policy implications are and also really look at what’s going on through the lens of cultural competence the suicides that we experienced were students from very different cultures and I’ll talk about that in more detail but just want to put the idea of cultural confidence as a backdrop in our discussions from further on this is Phil maleman from Georgetown and I want to very much agree with Greg that this is great foundational information it’s very important I think that the question of messaging in the media is is critical in one piece that I’d like to emphasize here is working with student media the the time to have the conversation about how to report a suicide is not right after the suicide occurs on a campus I think it’s at the beginning of the year where you call together the editors of the campus media the student media and you have a conversation with them and you present some of the information that we just saw on the screen here today this way they’re prepared so that when when or if the worst happens they they have some background on what to write in their stories and what not to write so I think you want to do some prevention if you will with the media the other thing I want to say is that postvention is very important and i’ll be talking about that in the second part of this webinar postvention in other words what you do after the fact to me is prevention because in the wake of suicide anyone who has ever had a suicidal thought tends to revisit it and it’s very important to have some have postvention going on so that those thoughts don’t mature into something actionable and we’ll be talking about that a little bit later the last piece that I want to mention is that if you in and this will come up in my part of the presentation that the messages you may give in a small group meeting would be very different than what would appear in the press and because oftentimes with postvention you’re working with people who know the person well who knew the circumstances well I heard reference in in some of the discussion today to the rumor mill the rumor mill runs rampant in the aftermath of a suicide and getting people good information those who are knowledgeable of the person in a first-hand way I think dispelling myths

and rumors is very important but that’s that’s on a more personal basis not in terms of media so we’ll get to that later this afternoon right thanks so much to all of you and what I’d like to do now is maybe begin to just leave in some of the questions that are coming from our listeners please continue to write in your questions will try to get to as many as we can and we will be sharing them with our panelists so the first one is actually a specific question someone wanted to know Maddie what you had on your slide of theories what approach avoidance conflict means okay good and um you know any questions that folks have because I went through very quickly so by approach avoidance but it really meant was that there was a pre-existing um thoughts about suicide or that they’ve already been approaching that there’s a conflict that already exists within a person so that someone may have had suicidal ideation before you know I have a number of the different factors that I had in that other side that listed vulnerabilities but that very were approaching you know being drawn to suicidal behavior but then at the same time avoiding it and so that there are many problematic behaviors that have that tension of sort of wanting to do something but not wanting to do something and there’s some equilibrium then that is then found within that person and then in the context of someone else’s suicide to get some balance that all of a sudden it gives more motivation to be approaching that you know behavior that they really are trying not to but that there’s some pre-existing conflict that exists though it’s another way of conceptualizing that vulnerability or pre-existing factors that may have made that person be thinking about suicidal behavior and that again that there’s a pre-existing conflict but the managing to keep things on the side of you know not engaging that behavior you can think of it as a you know as a weight as a scale then all of a sudden someone else’s behavior gets them to start perhaps ruminating about suicidal behavior more and then just tip that balance unfortunately on the you know towards engaging in the behavior so that that’s what that means men thanks so the question has come from the audience about and this is maybe part of a broader question about why is it that contagions and clusters are more common in the adolescent and young adult age group and the question I guess Part B is do we have any evidence that this communicability or contagion of ammo is more likely to happen among young people than than just people in general yeah um I’m assuming that’s for me too cause it’s Maddie where anyone I guess could be anybody Sen chime in but Maddie why you always start at least start with that I think that there are two things I you know we don’t definitively know why but these are two things that we you know that many people have considered number one is the nature of peer relationships as people move into adolescence and young adulthood changes younger you know kids are much more involved in family and then they you know puberty hits and so on and then their connectedness because they appear connectedness really gets to be enhanced and um they really are just much more involved in a peer community then they get older and get married or having no significant other and perhaps of children and so on and then the focus again is on an immediate family but during that time period of adolescence and young adulthood which is the ages that we saw in our you know examination of mortality data to be the ages where clusters and contagion were much more significant I think is really influenced by that appear connectedness another factor might be you know the neurobiology of young people in that you know we know that there are you know whether they want to accept this as a

reality but that um no cognitive or executive parts you know control parts of the brain the prefrontal cortex and so on isn’t it’s just not fully developed in adolescence and even young adulthood and so inhibitory control of behavior um is not quite the same as when they will you know a few years later that so that they might be on more impulsive and you know it might in the way that they don’t inhibit other inappropriate or impulsive behaviors they may not have quite the same ability to have that you know our people have described as a as a braking system so it’s probably both social and you know biological reasons that may um you know under underlie the the reason that it’s you know contagion is mainly among teenagers and adults and that on there seems to be evidence from you know the impact the stories the studies that have looked at the impact of the media generally not in a you know cluster situation as well that have also reported a great you know can be across the H stands at a greater susceptibility among teenagers and young adults and when you think about certain fads and shoes and you know various things that have nothing to do with suicide but social behavior you know you can start to really you know understand why um you know other behaviors in general seem to be more cold contagious in you know among teenagers and young adults this is virtue McCain I just wanted to add one other point I think I think I’m dr Gould has given a and an excellent summary of why suicide clusters are more common among adolescents and young adults I would just point out that the phenomena is not completely unknown among among adults so for example in l a– errands men who then internationally recognized suicide prevention researcher at the university of cork in ireland has has done work regarding a suicide cluster from men in in middle-aged men in the world community of Ireland so so just I think that that’s kind of an important caveat so on a college campus we wouldn’t want to think that it’s only the young people who might be vulnerable and there might not be for example you know perhaps a faculty member who is really struggling before a suicide cluster began to emerge who might not be influenced by what was experienced around them so that would be just a small caveat i would have had i think that’s a really important point Richard and you know there’s an irony here that we know that one of the social issues that’s protective against suicide as social cohesive pneus or the tightness of social ties and there is desire need while social cohesive mrs probably you know certainly protective there also seems to be the potential for risk we know that young people tend to create you know intense and sometimes very quick social connections and this can be a great source of support but it other circumstances can be a source of risk as well we have an interesting question I just like that oh sorry I just wanted to highlight you leverage that you mention it because we do know of situations in schools where teachers have been involved as well and so clearly you know it the strange that I in the pre-existing vulnerabilities but you know among adults have to be taken into account when a cluster occurs then that we know that I clusters are occurring in military units as well they tend to be younger so you may you know they guard adolescent adult so it’s not the adults but you know it’s the clusters are going beyond just the communities that we’re talking about today yeah right thanks to do we have any information we have a question from the audience about whether the obviously highly highly reported death of Robin Williams last summer had any impact on rates of suicide in the United States or in particular communities um you know we don’t know yet if it had an impact on rates of suicide into the mortality data isn’t available yet it’s usually available a couple of years you know after the year but we do know that the

rates and in fact I think Richard was part of that publication with John Draper from the National Suicide Prevention lifeline that and i think it was in the cdc morbidity and mortality report from what i remember but Richard probably you know would know better that the rates of calling the National Suicide Prevention lifeline went up which is you know could be considered a good thing you know and I think it’s because the messaging although some of the messaging was via really not what we would have recommended some other messaging was actually very useful after Robin Williams death with regard to accessing care via specifically in this case the National Suicide Prevention lifeline and so on that very dramatic increase in the rate of calls after his death um shows how when you do share you know resources of you know for help that you know folks who are worried about their suicidal thoughts you know then have a positive way to you know to deal with it so we do know that those rates went up in terms of undesirable rates we don’t know yet and another question and maybe Kerry you can address this in some of the work you’ve had with a number of the GLS campuses are there problems related to underreporting of campus deaths or suicides I mean one of the issues that has anecdotally emerged is that sometimes when there’s a delay or when there’s no reporting at all but you know other than around the kind of social media and rumor mill actually their suggestions that it might increase anxiety among the stew so on a campus yeah that’s a really interesting question I think certainly that is where it’s important to try to communicate what you do know even if you’re not really able to communicate very much and start providing some postvention grief support as soon as possible so that it doesn’t look inadvertently like the school is covering something up or trying to avoid talking about something I think you can had to deal with some of that in their suicides that happened in in recent years so really I think this is again points to the need to kind of get on top of announcing as much as you can within reason and starting your services to suicide survivors as soon as possible and I’m sure my other colleagues on on the webinar today can also share a little bit about their own on the ground experiences yeah I would just this is greg again i would just like to reiterate how i think a key concept around this is transparency when your philosophy as an institution has to be be as transparent as possible and they’re always going to be complexities with families with the nature of the suicide you know for us especially with suicides that are or high profile we made a very conscious decision in consultation with people like Maddie and other folks to say you know this is likely suicide to really comply with all the things that have been talked about it earlier but really come from that transparency position taking into account what’s going on with the families and some other things and in all honesty it the suicides are different if the clusters are occurring in much less public ways there’s going to be a different public response and sometimes transparency is often harder to balance with the wishes of the family or even getting a final ruling on whether it has a suicide or not so I think some of those things bring in additional complexity but that seeing this as this transparency is really being where you’re coming from we think is essential I think it’s a very important point a classic I’m sorry they are just against their um you bring up to me that I then want to highlight based on what you’re saying that you know clearly from today’s you know webinar and you know we’re saying that suicide contagion is real and exists but I then heard people say you know terms of you talk about underreporting but I’ve heard mental health professionals in the past say well you know what then they reluctant even ask about suicide because suicide contagion exist they’re afraid to ask about suicide for fear that you know will put ideas into people’s heads and so on and so you know i think we all wanted the will absolutely agree but you need to ask about suicide you definitely I mean you have to you have to add exactly and so that even though we’re saying that do such contagion exist and that cost of exist that isn’t the same that doesn’t support then you know that the idea that people sometimes have it then they are paid to ask about it operated I think asking within a clinical or a brain setting is very different than the kind of public messages or what goes on exactly right now University communication and there’s

a question related to this which I think again is really worth emphasizing a question about gatekeeper trainings which in many cases are sharing facts and figures about suicide and the questioner is asking whether based on what we’re saying there is a suggestion not to mention that suicide is the second leading cause of death for college students and I think what we’ve all been saying is that media and news reporting to a lay audience is very different from academic or educationally oriented settings in which you obviously need to share details and data and information in them in a much more expansive and deliberate kind of way yep and I just want to expand on this this carry that there’s research that shows that the general public already know is that suicide is a problem and what they know less about is how to prevent it so we’re really when we focus on the statistics that’s when we’re missing opportunities to really share what are you going to be able to do about it and your gatekeeper training efforts are going to be that effort of what are you going to be able to do to respond and I’m glad we were able to clarify that you know certainly using statistics are going to be important when you’re talking to key stakeholders or senior leadership to help convey how important suicide prevention is but again if the public already kind of know is that this is a problem we want to instead focus on those messages of hope recovery and what you can do to help others that have been seen to help be protective so it’s important again to recognize that these guidelines are a series of guidelines you need to think about the context and the setting and the balance of these things there’s nothing here that’s an absolute but you really need to become familiar enough and understand the thinking behind these principles enough to be able to work with this information in different kinds of settings well we’re we’re now at the top of the hour and it’s been a really packed hour and a half with a tremendous amount of information and and conversation so what we would do now is take about a half hour break we suggest that you keep your the computer the slides open and just as a reminder the slides the powerpoints will all be available to anyone who’s registered I think we’ll be planning to send them out and then they will be on the samsa sprc NJ foundation web sites along with the audio of this full webinar once everything is processed properly so you don’t need to worry if you missed something again the questions there were many questions we couldn’t get to we’ll try to get back to people as much as possible if there are other technical questions that come up will you know be able to share links and information going forward so again please keep the the webinar open on your computer screen if you want to put your phone on hold or just stay on you’ll hear music for the next 30 minutes or so this will give everybody a time to break and just catch up on whatever they need to and we will be reconvening for part two in just about 30 minutes thanks for joining with us for this important webinar