Instead of preparing for crisis, schools must learn prevention,
says doctor-turned-educator

Medical Gazette Editor

With suicides rising daily, prevention tool aims to help save the lives of students
Medical Gazette Editor - January 12, 2001


Homicide. Suicide. Gangs. Violence. Guns. Drugs and alcohol.

   Once thought relegated to the leprous streets of a big-city slum, they now have now infected many of America's schools. Weapons checks are no longer only an airport annoyance but sometimes a shakedown in the acned hallways of teen-age academia.
   The horrific example of Littleton, Colorado, and othersuch headline fodder have left little doubt that today's tragedies can happen anywhere. New York City. The Bible Belt. America's Bread Basket. Right here in River City.
   In the case of Littleton, two teen boys shot, killed and maimed dozens of fellow students before taking their own lives.
   "Why didn't teachers communicate? Why didn't the students communicate? Because the teachers are left out of the loop. The students are left out of the loop."
   So says a San Antonio physician who has become an ardent advocate of "education" as a poultice for our sometimes-fevered school systems.
   Saul Wilen, M.D., is chief operating officer of of International Horizons Unlimited, an education consulting firm headquartered in San Antonio. IHU has produced a school suicide prevention program. The firm is in production of a violence prevention series and eight other school emergency management issues training modules for educators and students.
   Wilen's national educational consulting and resources firm specializes in problem solving and the application of viable solutions for all industries.
   The educational consulting firm has developed an innovative, new computer-based tool for suicide prevention for use in elementary, middle and high schools.
   In conjunction with JRP Technologies, IHU recently completed the suicide prevention tool, which consists of four CD-ROM modules, each oriented to a different target audience within the educational system. Administrators, counselors, teachers and students are included in this team-based approach.
   Wilen says the company's program is the first in the United States to include teachers, "and we're the only program in the world to include students."
   "Suicide prevention is a good one to use as a hallmark of what we're really all about" at IHU, he says.
   "They're all related: gangs, drugs, alcohol, violence, suicide."
   Work by Wilen's colleague, Dr. Ruth Fagan, a project development consultant and professor of social work at the University of Texas at Austin, shows that people who commit homicide are often suicidal themselves.
   The school violence that captured headlines over the past year or so has been perpetrated by students who were themselves suicidal, Wilen reiterated in an interview with the field publication Counseling Today, published in July 2000. "So it may not just be one life that is saved by the mastery of prevention techniques."
   "Annually there are 20,000 to 21,000 homicides compared to 31,000 suicides," Wilen says. "At school age, for every one suicide there are 100 to 200 attempts - not just thinking about it, actual actions. Fifty percent of all adolescents have contemplated suicide."
   Those are not his numbers, Wilen says. They come from the National Institutes of Health, the Centers for Disease Control and the American Association of Suicidology.
   The U.S. Surgeon General has declared suicide a public health emergency. "It's frightening. We're in an epidemic."
   Suicide claimed the lives of more than 30,000 Americans in 1997, according to the most recent data compiled by the American Association of Suicidology. This number includes more than 4,000 people under the age of 25, making it the third leading cause of death among young people. But in spite of these tragic statistics, our response has been largely one of crisis management versus actual prevention, according to a July 2000 article in Counseling Today.
   Ever since Littleton, says Wilen's colleague Larry Stewart, "You find crisis management industry is flourishing in schools." Most of such programs are centered on what to do after a crisis occurs, he says. Conversely, "We are crisis prevention. Our attitude is these things are not earthquakes. We do teach crisis management - just after the prevention is established.
   According to Wilen, the program's goal is to "educate to prevent suicide" by teaching early recognition of danger signs and means of proactive intervention. It also includes a guide for communication before, during and after a crisis.
   The idea for the program emerged eight years ago when many of the consultants with whom Wilen works began to "express concern about the devastating impact of suicide, drug and alcohol abuse, violence and other problems on their communities, schools and workplaces," he told Counseling Today.
   IHU formed study groups on the issues to determine what sort of approach would work best to combat them. Suicide was the first problem they examined.
   "This growing problem, especially among our young people, really underscores the need for a comprehensive suicide prevention initiative in our communities." has really come to be defined as intervention and crisis management after the fact," he told the journal. "This stems partly from an unwillingness on behalf of many of us to openly discuss issues such as suicide."
   "No one has been willing to do the two things necessary to deal with these issues," Wilen says. "The first is to talk about them. There seems to be a universal fear that if you talk about them they will occur more, that if you put it in the closet then there's no more problem. What we've found is that if you put it in closet it's actually a bigger problem."
   JRP Technologies designed a multi-media that is a team-based school suicide education tool for creating the "Total School Prevention Team."
   "Change will not occur unless there's a grassroots campaign for change.
Every member of the school community must be on this prevention team. Every teacher, student, parent, board member You don't need 10 crisis teams. You need one proactive team."
   "To effectively prevent and intervene, all stakeholders in the education process (administration, staff, faculty, students, parents, school board, law enforcement, and the community in general) must be involved with understanding the at-risk factors that impact safety.
   "In looking at the measures that were already in place, we found that almost all schools do have what they refer to as a "crisis management team'," Wilen told the journal. "But only about 10 percent have ever actually met, and 1 percent have ever gone through any sort of exercise together."
   In some cases, he said, some of the members did not even know that they were part of the team.
   A case in point was San Antonio's Judson Independent School District, which began working with the IHU program in 1999.
   "We basically had a program in place to deal with the aftermath of a suicide or other act of violence, but nothing that amounted to true prevention," Charles Neumeyer, associate superintendent of the 16,000-student JISD told Counseling Today.
   "Kids have been shot. There are suicides in our community," says Jeannie Palmer, director of guidance and testing for the JISD. She has been in education for 22 years and counseling for 12 and says there is an increase in the awareness of depression and suicide.
   It is too early to tell the impact of the program at JISD, where it is still in the initial stages, Wilen says.
   Ideally, Wilen told the journal, full implementation will be accomplished over the course of three years, which gives schools an opportunity for reinforcement and updates of the system.
   "We are really enthusiastic about the potential of this product," Wilen told the journal. "If we can provide more information and more stimulus to enable those involved in education to really prevent such tragedies, then perhaps they will move a step closer to focusing on what school should be all about - that is learning and preparing our young people for the future."
   The Suicide Prevention and Education program is currently available from International Horizons Unlimited. Wilen said the company will work with schools who are interested in purchasing the program to help meet their needs.
   For more information, see the International Horizons website at or contact the company at International Horizons Unlimited, Corporate Center, 4207 Gardendale, Suite 105, San Antonio, Texas 78229.

Wilen, has been tapped as the keynote speaker at the Texas School Safety Summit being held at Austin's Holiday Inn Airport South on Jan. 29 at 9 a.m. The keynote address is entitled "Safety: A Cornerstone for Effective Learning" and will stress the need for students and staff to feel safe at school if effective learning and teaching are to occur. On Jan. 31 the firm is producing seminars on suicide prevention and educational accountability for the Texas Education Agency's Midwinter Administrator's Meeting being held at the Austin Convention Center. Information is available on the PROJECTS page at or by calling 210-692-1268

What would you do if one of your friends threatened to commit suicide?

  • Would you laugh it off?
  • Would you assume that the threat was just a joke or a way of getting attention?
  • Would you be shocked and tell him or her not to say things like that?
  • Would you ignore it?

If you reacted in any of those ways you might be missing an opportunity to save a life, perhaps the life of someone who is very close and important to you. You might later find yourself saying, "I didn't believe she was serious," or "I never thought he'd really do it."
   Suicide is a major cause of death. The American Association of Suicidology estimates that it claims 35,000 lives each year in the United States alone; authorities feel that the true figure may be much higher. A growing number of those lives are young people in their teens and early twenties. Although it is difficult to get an accurate count because many suicides are covered up or reported as accidents, suicide is now thought to be the second leading cause of death among young people.
   If someone you know is suicidal, your ability to recognize the signs and your willingness to do something about it could make the difference between life and death.

Danger Signs
No doubt you have heard that people who talk about suicide won't really do it. It isn't true. Before committing suicide, people often make direct statements about their intention to end their lives, or less direct comments about how they might as well be dead or that their friends and family would be better off without them. Suicide threats and similar statements should always be taken seriously.
   People who have tried to kill themselves before, even if their attempts didn't seem very serious, are also at risk. Unless they are helped they may try again, and the next time the result might be fatal. Four out of five persons who commit suicide have made at least one previous attempt.
   Perhaps someone you know has suddenly begun to act very differently or seems to have taken on a whole new personality. The shy person becomes a thrill-seeker. The outgoing person becomes withdrawn, unfriendly and disinterested. When such changes take place for no apparent reason or persist for a period of time, it may be a clue to impending suicide.
   Making final arrangements is another possible indication of suicidal risk. In young people, such arrangements often include giving away treasured personal possessions, such as a favorite book or record collection.

What To Do
If someone confides in you that he or she is thinking about suicide or shows other signs of being suicidal, don't be afraid to talk about it. Your willingness to discuss it will show the person that you don't condemn him or her for having such feelings. Ask questions about how the person feels and about the reasons for those feelings.
   Ask whether a method of suicide has been considered, whether any specific plans have been made and whether any steps have been taken toward carrying out those plans, such as getting hold of whatever means of suicide has been decided upon.
   Don't worry that your discussion will encourage the person to go through with the plan. On the contrary, it will help him or her to know that someone is willing to be a friend. It may save a life.
   On the other hand, don't try to turn the discussion off or offer advice such as, "Think about how much better off you are than most people. You should appreciate how lucky you are." Such comments only make the suicidal person feel more guilty, worthless, and hopeless than before. Be a concerned and willing listener. Keep calm. Discuss the subject as you would any other topic of concern with a friend.

Get Help
Whenever you think that someone you know is in danger of suicide, get help. Suggest that he or she call a suicide prevention center, crisis intervention center or whatever similar organization serves your area. Or suggest that they talk with a sympathetic teacher, counselor, clergyman, doctor or other adult you respect. If your friend refuses, take it upon yourself to talk with one of these people for advice on handling the situation.
   In some cases you may find yourself in the position of having to get direct help for someone who is suicidal and refuses to go for counseling. If so, do it. Don't be afraid of appearing disloyal. Many people who are suicidal have given up hope.
   They no longer believe they can be helped. They feel it is useless. The truth is, they can be helped. With time, most suicidal people can be restored to full and happy living. But when they are feeling hopeless, their judgment is impaired. They can't see a reason to go on living. In that case, it is up to you to use your judgment to see that they get the help they need. What at the time may appear to be an act of disloyalty or the breaking of a confidence could turn out to be the favor of a lifetime. Your courage and willingness to act could save a life.

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