The Role of Secondary School Teachers in Preventing ...€¦ · Preventing Student Suicides and...

© 2016 All rights reserved by CSRP, HKU

The Role of Secondary School Teachers in Preventing Student Suicides and Promoting

Positive Development of Students

Prof. Paul YipDirector

Centre for Suicide Research and Prevention

26 Oct 2016


About us

We are:

• a knowledge hub for good practices on suicide prevention

• generate and advance knowledge in suicide studies through

vigorous scientific research

• build evidence-based indigenous working models for people with

suicide ideation, attempters, as well as survivors through

community-researchers collaboration

• transfer skills and knowledge to front-line professionals through

workshops, resource production as well as opportunity of

practicum training

• contribute to the formulation of social and health policies in

combating the problem of suicide


Suicide in Hong Kong


Number of Suicides and Suicide Rates in Hong Kong, 1997-2015

^ According to data from the Coroner's Court, with

registered death date up to 30 June 2016, there were

858 (880) suicide cases in 2015.

^ From the CSRP experience, there will be more cases to

be confirmed in 2015. We estimated that there were about

921 (945) cases in 2015 by adjustment with 2014.


Suicide Rates in Hong Kong by Gender, 1997-2015

^ Registered death date up to 30 June 2016. Estimation

of suicide death in 2015 by adjustment with 2014.


Suicide Rates in Hong Kong by Age Groups, 2007-2015




International Comparison on Suicide Rates

Global Korea Japan US Australia HK UK Taiwan


International Comparison on Suicide Rates (aged 5-14 & aged 15-29)

Korea Japan US Australia HK UK Taiwan


Number of Suicides and Suicide Rates of Youths (Aged 15-24)

in Hong Kong by Gender, 2007-2015




Both Genders Male Female

2014 2015^ 2014 2015^ 2014 2015^

Number of youth suicides 57 70 38 54 19 16

Number of full-time student suicides 17 23 12 16 5 7

Proportion of full-time student

suicides among all youth suicides29.8% 32.9% 31.6% 29.6% 26.3% 43.8%

Number of youth 835 200 808 800 421 400 407 800 413 800 401 000

Proportion of full-time students*

among all youths62.3% 55.8% 62.6% 56.8% 62.1% 54.8%

Student vs Non-student Suicides among Youths (Aged 15-24), 2014 & 2015

^ Registered death date up to 30 June 2016. Estimation of suicide death in 2015

by adjustment with 2014.

*Estimation based on General Household Survey, Census & Statistics Department.

*Include all students attending full-time courses in schools or educational institutions.

*Exclude students attending secondary day courses operated by private institutes.


Progress report by Committee on Prevention of Student Suicides (July 2016, p.5-6)

Based on the reports of the 34 student suicides cases (2013/14,

2014/15, 2015/16 school year):

― Mental health: about 20% of the cases had been diagnosed with mental

illnesses, including early psychosis, depression and anxiety disorders.

― Adjustment: about 80% of the cases had been identified with adjustment

issues related to family or education

― Relationship: about 85% of the cases have relationship problems with

peers or family

― Emotion problems: about 60% of the cases were affected by emotion

problems, including having negative thoughts about life, encountering

immense academic-related stress, or having suicidal thoughts.

Over 90% of 34 cases showed complex pattern in more than one area of

the above concern, and about 47% exhibited more than two areas of

concern Suicide is caused by multiple factors


Media and Suicide


Jan,

2015

Feb,

2015

Mar,

2015

May,

2015

Apr,

2015

Jun,

2015

Jul,

2015

Aug,

2015

Sept,

2015

Oct,

2015

Nov,

2015

Dec,

2015

Jan,

2016

Feb,

2016

Mar,

2016

Apr,

2016

0

10

20

30

Ag

e

T

788 538 615

T

584692

Jan 2015 – Apr 2016 Student suicide in Hong Kong

Concern letter sent

2015 N=19;

2016 N=20;

total 39 cases

Published at A1/A2 page

0

10

5

Nu

mb

er o

f su

icid

e d

ea

th

T

T

335

621

T

414

T

425

T

689

T

862

321

587

737

T

735

T

377

247

T

670

T

697

T

752

T

294

T

472

344

732

544

565

778

T

247

355

696

764

595

363

416

250

T

T T

T

487

520

511

41

1

Male

Female

T Tertiary student


Jan,

2015

Feb,

2015

Mar,

2015

May,

2015

Apr,

2015

Jun,

2015

Jul,

2015

Aug,

2015

Sept,

2015

Oct,

2015

Nov,

2015

Dec,

2015

Jan,

2016

Feb,

2016

Mar,

2016

Apr,

2016

0

10

20

30

Ag

e

788 538 615 584692

Jan 2015 – Apr 2016 University Student Suicide in Hong Kong

Concern letter sent

2015 N=12;

2016 N=8;

total 20 cases


0

6

5

Nu

mb

er o

f su

icid

e d

ea

th

621

414

425

689

862

735

377

670

697 752

294

472

247

250

487

4

3

2

1

Male

Female


Jan,

2015

Feb,

2015

Mar,

2015

May,

2015

Apr,

2015

Jun,

2015

Jul,

2015

Aug,

2015

Sept,

2015

Oct,

2015

Nov,

2015

Dec,

2015

Jan,

2016

Feb,

2016

Mar,

2016

Apr,

2016

0

10

20

30

Ag

eJan 2015 – Apr 2016 Secondary & Primary School Student Suicide in Hong Kong

Concern letter sent

2015 N=7;

2016 N=12;

total 19 cases


0

Nu

mb

er o

f su

icid

e d

ea

th

335

321

587

737

247

344

732

544

565

778

355

696

764

595

363

416

520

511

41

1

6

5

4

3

2

1

Male

Female


Introduction of

Public Health Approach


Public Health Approach: Aims

Public health aims at maximizing the benefits of the largest no. of

people (WHO, 2014)

For suicide prevention (WHO, 2010):

To identify the patterns of suicide and suicidal behaviours of a

group or population;

To create a protective environment; and

To change the behaviours that put people at risk

World Health Organization (2010). Towards evidence-based suicide prevention programmes. Phillippines: World

Health Organization, Western Pacific Region.

World Health Organization (2014). The public health approach. Retrieved from

http://www.who.int/violenceprevention/approach/public_health/en/

http://www.who.int/violenceprevention/approach/public_health/en/


Public Health Approach: 4 processes

Mercy and Rosenberg 2000, Powell, and Kachur 1995, Potter, Rosenberg, and Hammond 1998, US Department of Health and Human Services 2001

Towards Evidence-based Suicide Prevention Programmes, WHO 2010

Evaluation 評估What works?

Prevention / Intervention 預防／介入How do we do it?

Risk (Protective) Factor Identification風險因素識別

What’s the cause?

Surveillance 監測What’s the problem?

Problem 問題 Response 應對

All rights reserved. CSRP HKU © 2014

18


Public Health Approach: Interventions

Source: WHO. (2010)

Tip of the

icebergIndicated

The entire population• Community-based suicide

prevention programs

• School-based mental health

enhancement programs

• Limiting charcoal access

• Psychoeducational

websites

Subgroups with risk factors• Low-income family

• Divorce household

• Mental health problems

• Mentorship program

High-risk individuals• Volunteer mentorship: help young

adults with DSH behaviour

Projects

Universal

Selective

Botto

ms u

p a

ppro

ach


Source: P.S.F. Yip. (2005)

1. To create a protective environment

2. Change behaviours that put people at riskCritical

suicidal risk

Suicidal risk

% o

f p

op

ula

tio

n

μ1

Reduction

in number

of suicides

μ2

Public Health Approach: Aims


The Roles of Teachers in

Suicide Prevention and Positive

Development of Students


Ownership and Leadership


Public Health Approach for Suicide Prevention in School Setting – some suggestions

Universal level

Mental health and suicide awareness

enhancement programmes for whole

school

Student mental health programmes

Positive, caring and supportive school

environment

Selective level

Gatekeeper training for teachers and school personnel

Selective programmes for

students with additional needs

Indicated level

Connect medical and psychosocial

services for students in need

Crisis management protocol


Universal level


A1. Universal level - Mental health and suicide awareness enhancement programmes Mental health awareness talk

― Common mental disorders and its impacts

― Relationship between mental disorders and suicide

― Develop and maintain good mental health

Suicide awareness talk

― Suicide in Hong Kong

― Suicide myths and facts

― Risk factors and protective factors of suicide

― Basic skills to support people with suicidal ideation

Awareness

Alertness

Action


A2. Universal level – Student mental health programmes Allocate specific lessons for teaching knowledge and skills that can

strengthen students’ problem solving skills, emotional management,

communication skills etc.

Example of student programme developed by CSRP:

Dimension Themes Content

Psycho Character strength Self-awareness of personal strengths

Practice character strengths

Emotional management Cognitive Behavioral Theory

ABC Model

Mindfulness + Relaxation

Goal setting SMART Goal setting

Problem solving 6-step problem solving skills

Social Empathy Accepting emotions and empathy

Gratitude Appreciation of Self

Thankfulness toward others

Communication skills Active Constructive Responding Skills

Verbal and non-verbal communication


Results


A2. Universal level – Student mental health programmes

Teachers are encouraged to receive

training and deliver mental health

programmes for students, esp.

homeroom teachers

Provide long term support to students

Increase programme sustainability

A delayed effect was observed at

follow-up assessment for the

participants of the teacher-led group

in reducing anxiety and stress levels

(Lai et al., 2016)


A3. Universal level – Positive, caring and supportive school environment

Whole-school approach

Create a positive school environment for both teachers and

students

Not only standalone programmes


Recommended Hidden CurriculumSecondary schools

Gratitude tree (感恩樹)

- To show our gratitude to different people/things in written form and

display in schools

- To foster a grateful attitude among students, teachers and school staff

Kindness Encouragement Scheme (好人好事計劃)

- To share good behaviours of students in morning assembly andacknowledge their good deeds in order to promote kindness

One person one role (一人一職)

- To enhance the scheme by including different types of roles, like Caring

ambassador, Reading ambassador etc.

- To promote responsibility and sense of belongingness

Birthday celebration (生日繽紛樂)

- To organize class-based birthday party to foster a positive classroomenvironment and student-teacher relationship

Secret Angel (秘密天使)

- To promote a caring and supportive environment within the classroomby doing nice things to each other

Warm call (陽光電話)

- To inform parents about good behaviours of their child on a regular

basis to demonstrate how to see the positive sides of students insteadof the negative sides


Positive Education Model

Source: Norrish, J.M., Robinson, J. Williams, P. (2011). A model for positive education. The Geelong Grammar

School, Institute of Positive Education.


How can we flourish Positive Education in school?1) Learn it

To equip school personnel with the skills of positive education

2) Live it

To help them to live in the tenets of positive education

3) Teach it

To teach and integrate it into formal curriculum as Chinese or English

To integrate the key concepts into other subjects

4) Embed it

To apply and use it as a common language in school

To adopt a whole-school approach and promote it as a culture, such as “what

went well” boards and involving all stakeholders of school

Source: Norrish, J.M., Williams, P., O’Connor, M., Robinson, J. (2013). An applied framework for positive education.

International Journal of Wellbeing, 3(2), 147-161.


Selective level


B1. Selective level – Gatekeeper training

To equip oneself as gatekeeper of student suicide

Attend skills training workshop for guidance teachers, school

social workers and other related school personnel

Example of gatekeeper training by CSRP:

1. Epidemiology of Suicidality

A. Epidemiology of suicide locally and worldwide

B. Risk and protective factors: mental illness, socioeconomic factors, and

social support C. Review of effective suicide prevention and intervention measures

2. Risk Assessment

A. Risk assessment B. Identification of warning signs

3. Intervention

A. Crisis Intervention and formulation of action planB. Case Discussion

4. How to support families and friends of attempted suicide cases


B2. Selective level – Selective programmes for students with additional needs Allocate resources to support students with additional needs

E.g. emotional management, social skills training, tutoring

Evidence-based with programme evaluation


Indicated level


C1. Indicated level – Connect medical and psychosocial services for students in need

Referral system in school and make it known to all teachers and

school personnel

E.g. refer to guidance teachers or school social workers

Inform students and parents about the support available in school


C2. Indicated level – Crisis management protocol

Set up a crisis management protocol for suicide and ensure all

staff involved know about it


As a teacher……

Develop positive relationship with students

― Create a personalized classroom environment, as simple as

remembering the names of students, can reduce classroom anxiety

― Good relationship can motivate students to come to school and

work harder if they can feel the care and trust from teachers

― As an adult mentor and provides opportunity for students to learn to

interact with an adult, find their own identity and prepare for future

path

― (Bernstein-Yamashiro & Noam, 2013)

Identify students’ character strengths and facilitate its

development and application (6 virtues and 24 character

strengths from Positive Psychology)

Bernstein-Yamashiro, B. & Noam, G. G. (2013). Relationship, learning, and development: a student perspective.

New Directions for Youth Development, 137, 27-44. doi: 10.1002/yd.20046


Centre for Suicide Research and Preventionwebsite - #WeCare

http://wecare.csrp.hku.hk此專頁旨在為關注學生自殺的各界人士提供幫助。我們整理了青少年自殺風險因素、預警訊號、社區可以提供幫助的資源、如何與青少年傾談的技巧等，亦針對不同的人士（例如傳媒、網民、家長、學生、校長、老師等）提供具體的跟進建議。

http://wecare.csrp.hku.hk/


Centre for Suicide Research and Prevention -Facebook

https://www.facebook.com/hkucsrp

https://www.facebook.com/hkucsrp


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