CHAPTER 10

MENTAL HEALTH SUPPORT FOR DISTRESSED STUDENTS WITH GIFTS AND TALENTS

Healing a suicidal mind is very difficult and not always successful. It requires considerable expertise in psychology or psychiatry. Consequently, it is not appropriate to include actual counseling advice here per se, as this book is for the general public and its readers are not expected to have the training required. Teachers, administrators, parents, fellow students, and even most school counselors should not be considering how to counsel a suicidal student with gifts and talents, but how to direct that student to professionals who can help. There are myriad factors that influence the potential for success in turning around a mind bent on suicide. Some of these include access to mental health professionals and the type and degree of comorbid factors. When a person is identified as potentially suicidal, assessing his or her risk of imminent harm is often the first step of treatment. The goal for assisting a person believed to be at this level of distress is simple and direct: keep him or her alive. Typically this leads to in-house care at a residential facility that specializes in serious mental health care. Those admitted often stay for 48–72 hours. They must be reevaluated for the potential of imminent harm before they can be released. In a perfect world, they remain as an outpatient, receiving appropriate psychological care on an outpatient basis. The treatment often includes both talk and potentially pharmaceutical therapy. Psychologists tend to provide the talk therapy while psychiatrists arrange the medications. Psychiatrists sometimes offer both services. Other combinations can also exist, such as clinical social workers, or other professionals licensed at the master’s degree level who are supervised by licensed doctoral-level psychologists or psychiatrists. Specific techniques for therapy will vary based on the philosophical underpinnings of the training received by the psychologist providing the therapy.

Once the person is out of imminent harm, or if he or she was never in imminent harm, the most highly recommended approach includes both counseling and medication (if called for). One without the other, when both are recommended, is believed to be an inferior approach to treatment. Although describing a typical acute care medical model of healing a suicidal mind is important, this task is out of the hands of those who work in schools. Moreover, care after a person has been suicidal is inherently ameliorative. Much of this work is best done by highly trained professionals.

IN THE PRESENCE OF A POTENTIALLY SUICIDAL INDIVIDUAL

We know that a person in imminent danger of harming him- or herself should be placed in the care of professionals. Once a person is identified as suicidal and receiving appropriate psychological care, he or she should be among the professionals who can save him or her in the short term and help make the move from suicidal to stable. But many of the situations in which those of us who work or live with gifted students find ourselves are more ambiguous. How does a teacher who spots a student whose work is laced with death-related images or who appears self-loathing respond? When is it time to seek support from a professional? How does one act in the moment when faced with a depressed child? How can we create an environment that supports positive development, so the pain of psychache never enters?

To foster an environment where psychache does not emerge, adults must be on the lookout for students in psychological pain. As the spiral model illustrates, adults should be wary of life events that can throw their students with gifts and talents off the plane of positive mental functioning. Transition points, such as a move from elementary to middle school or middle school to high school, family moves that result in many changes, divorce, and death of a loved one (even a pet) are all precipitating events that can upset the balance on the plane of positive function. Those with predisposing or contributing factors (see Table 10, p. 27) should receive special attention. Adolescents who have made previous attempts or those who have poor coping skills may not be able to hoist themselves up from the lower levels of the spiral. Adults and peers can provide the support that is required, but concern for the individual is a necessary ingredient for success. A second ingredient is knowledge about what to do. It is important not to minimize students’ reaction to a situation. Their perspective must be taken seriously, or they will not feel supported. It can help to work on their perceptions of a situation, but an adult’s belief in the insignificance of the problem will not be helpful in doing so.

Peers can be a primary source of support, but it is extremely important to help them recognize their limitations. It is unfair to burden a peer with the responsibility of keeping a friend from falling into hopelessness. The responsibility he or she feels for the life of a peer is likely to go far beyond what an adult would feel. In order to respond appropriately, young people and adults alike must have proper education. What should someone say to a friend who expresses suicidal thoughts? When is it necessary to bring an adult into the situation? What adult is the right one? All schools should have at least one contact person who is available, sympathetic, and trusted by students and educated in the steps to take in the case of a suicidal child. All adults, including parents, should be trained in appropriate interventions—how to recognize a suicidal student, what to say, who to report it to, and when to report it. No one can be apathetic, or the student’s slide down the spiral will continue unimpeded.

If teachers, counselors, parents, and administrators work together on the prevention of suicidal behavior of students with gifts and talents, the odds improve dramatically. Others, such as psychologists and psychiatrists are available, should the more proactive measures taken give way to bad experiences, changes in brain physiology, suicidal correlates, or traumatic events that can accumulate to move a person downward on the spiral model of the suicidal mind of gifted children and adolescents. Should that occur, all of the adults and fellow students should be prepared to play their respective roles to help the student in distress. With sufficient training, we can create a formidable team to prevent suicidal behavior and lend our support to the healing of the suicidal mind of gifted children and adolescents.

The role of a caring community is to establish a safe haven for students, teachers, counselors, and administrators. By creating a caring community, all of the stakeholders are trained on steps to take to keep a watchful eye for those in need of assistance. We believe that it is important to include the salient information about the unique aspects of the lived experience of gifted students in the training of the stakeholders in the caring communities. This allows for idiosyncratic developmental patterns of gifted students to inform the stakeholder practices. This would include identifying early evidence of distress and bringing appropriate resources to bear to keep potential significant problems from emerging. Should a student get to a place of significant distress, stakeholders in caring communities know how to bring the person in need—both figuratively and literally—to the appropriate designated professional who can provide the next level of care. At this point, the training allows appropriate decisions to be made as to whether a referral is needed. In short, our best chance at helping gifted students relative to suicidal behavior is to try to prevent it from occurring. This includes ideation, attempts, and completions. To that end we must learn about suicide, including its manifestations, patterns, correlates, and factors. We need to keep an eye out for students in distress and know what depression and anxiety look like in school-aged children. We need to understand that suicidal behavior has a primacy of experience that we may never have experienced ourselves. We need to understand psychache and hopelessness. We need to stay vigilant and be willing to act. We need to have the confidence to know that we will not cause a suicide, and we may be able to prevent one. When in doubt, do something (Cross et al., 1996)!

KEY POINTS

School-based stakeholder groups (teachers, counselors, administrators, parents) can be the first line of defense in suicide prevention efforts.

Only suitably trained counselors, clinical social workers, psychologists, and psychiatrists can give effective psychological support to gifted students who are suicidal.

The appropriate role for teachers, administrators, parents, fellow students, and even most school counselors in the company of a potentially suicidal student is one of caring supporter who can guide her or him to trained professionals.

A proper referral is quite often the most appropriate step to take to prevent a suicide attempt.

Preventing suicidal behavior is the most effective approach to keeping students alive.

Adults should be on the lookout for students in psychological pain, especially when they have experienced major life events, such as transition points in school or the death of a family member or pet.

Schools can create caring communities that can be a robust defense against suicidal behavior.