Like Parkland, Downingtown, Pa., faced a teen suicide cluster. Here’s what schools can do.

After two student survivors of the mass shooting in Parkland, Fla., took their lives this month, high school and community officials there are urgently searching for ways to prevent more loss.

They’re concerned about suicide contagion — when the suicide of one person or multiple people contributes to a rise in suicidal behaviors among others, especially in the same community.

School administrators in Downingtown have been struggling with this same issue. Since February 2018, two current students and two recent alumni of Downingtown High School East have died by suicide.

Research shows that in communities where someone kills themself— whether it’s a school, military unit, or close-knit town — everyone else is more at risk for suicide too. In recent years, clusters of suicide deaths have been seen in schools across the country, from Utah to Massachusetts. Suicide now is the second-leading cause of death among teenagers.

Unfortunately, there’s not one optimal solution, said April Foreman, a licensed psychologist and board member of the American Association of Suicidology. “It’s an area which doesn’t have a lot of research, so there really isn’t a perfect standard for it,” she said.

But there are a number of steps mental-health experts believe can help schools reduce the community’s risk.

In Parkland, the school district has offered an ongoing resiliency center in town with counselors and support groups since the shooting at Marjory Stoneman Douglas High School last year. Officials are now discussing ways to offer additional therapeutic services for those affected by the recent suicides.

After the four suicides at Downingtown East, the school district provided extra counselors for students to speak with, held community forums for students and parents to voice their concerns, and offered training for students and teachers on how to recognize someone at risk for suicide. Administrators declined requests for an interview but wrote in an email that the district is reviewing the comments made at community meetings to inform ongoing efforts.

The most important thing schools can do is to be proactive, said Terri Erbacher, a suicide prevention consultant who has worked with more than 50 schools, including Downingtown East, and cowrote the book Suicide in Schools. “It’s about always thinking of the next person who might be at risk," she said.

A suicide cluster is generally considered a few related suicide deaths, Foreman said, but there’s no standard number. The two students in Parkland could qualify as a cluster just as much as the four deaths in Downingtown.

What is certain, though, is the impact a cluster has on others in the community.

“That group of students and teachers — those closest to the students who died — are going to be at elevated risk of suicide for the rest of their lives,” Foreman said. “It’s a long-term problem, not a short-term crisis.”

That doesn’t mean everyone affected by a loved one’s suicide will kill themself, but those who have previously thought about suicide or have a mental illness are at greatest risk.

It’s crucial for schools to identify those students and faculty early on, Erbacher said. The size of that most at-risk group can determine the type of response needed. Maybe having a few extra counselors onsite for a week will help, or maybe students need to be referred to long-term therapy with someone outside the school.

One thing that should always be done, Erbacher said, is to train administrators, teachers, parents, and students in recognizing the warning signs for suicide and learning to ask individuals directly if they’re thinking of killing themselves.

That question can be uncomfortable, Erbacher said, but people need to be direct. She suggests language like: “You’ve been through a lot with the loss of your friend. Is suicide something you’ve thought about?”

“The student might say no right there, but they will remember you asking them,” she said. “They’ll know you’re a safe person to talk to in the future.”

This idea is the cornerstone of a national curriculum on suicide prevention called QPR — question, persuade, refer. In QPR sessions, participants practice asking each other about suicidal thoughts in an attempt to make it easier in the future.

QPR was used to train students and staff at Downingtown East earlier this year and is also used regularly to train college students and faculty at local universities.

Ideally these types of trainings are in place before a suicide occurs, Erbacher said. Incorporating mental health and suicide prevention into regular school curriculums would help address the problem before it begins.

“You want to already have the policies in place, so you don’t have to be reactive,” she said.

In Pennsylvania, a law passed in 2014 requires all school districts to adopt a set of policies for suicide prevention and train educators in grades six through 12 in suicide prevention once every five years. But it does not set standards for teaching students about suicide prevention.

While people generally mean well, some common actions taken after student suicides can have unintended consequences, Erbacher said.

Take candlelight vigils.

The large turnouts and the tributes glamorize suicide, Erbacher said. “If someone else is considering suicide, they see that glamour and now suicide becomes a little bit more of an option for them.”

While it’s important to give communities an opportunity to express their sorrow, there has to be a careful balance between healing and glamour, she said.

Foreman also advises people not to come up with a simple explanation for what caused the person’s action. Suicide is rarely the result of any one factor like bullying or social media, she said. Simplifying it can blind people to the numerous warning signs.

“Suicide is a complex and difficult problem to tackle,” she said. That’s why there aren’t just one or two clear solutions that schools can use to prevent suicide clusters.

“Much like any major medical condition,” Foreman said, “the best thing you can do is reach out to professionals for support.”

If you or someone you know is thinking of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text TALK to the Crisis Text Line at 741741.