High school students across the United States are learning how to save
lives through a school-based mental health education and screening program
that enables them to recognize warning signs of suicide in their peers and,
quite literally, to act.
Just as the acronym CPR has become universal shorthand for a medical
emergency rescue technique, the Signs of Suicide (SOS) program teaches
students an acronym for a rescue technique of a different sort: ACT, which
stands for acknowledge, care, and tell.
After learning how to recognize the signs of suicide in a peer, students
are encouraged to acknowledge those warning signs and take them seriously, let
the peer know he or she cares, and tell a responsible adult.
Screening for Mental Health Inc., a nonprofit mental health screening
organization based in Wellesley, Mass., launched the SOS program in 2000.
Screening for Mental Health is the organization that founded National
Depression Screening Day (NDSD) in 1990.
According to psychiatrist Douglas Jacobs, M.D., executive director of the
SOS program and founder and director of Screening for Mental Health, the SOS
program was an offshoot of NDSD.
"We kept receiving requests from the NDSD sites to provide them with
materials suitable for teens," he told Psychiatric News."
We responded with the SOS program."
The program, he continued, provides teens with a "mental health
checkup, as well as the knowledge to recognize depression and the warning
signs of suicide when they occur in themselves or a friend."
High school students at participating schools first watch a 20-minute
video, "Friends for Life," which includes interviews with young
suicide survivors as well as information about depression and suicide from
school-based mental health professionals and other experts such as Jacobs.
The video also shows vignettes in which two students, one of whom is
depressed and potentially suicidal, interact with one another. Through the
dramatizations, students are instructed on the correct and incorrect ways to
approach the person who has become withdrawn, verbalizes a wish to hurt
himself or herself, or expresses hopelessness about the future.
When a girl tells her brother in one vignette that the boyfriend who
recently broke up with her "was the only good thing in my life"
and expresses a wish to die, the scene is then played out in two different
In the first vignette, her brother tells her she can handle things and
should "snap out of it." In the replay of the scene, the brother
tells his sister he's worried about her and encourages her to talk to an adult
they know. He promises to accompany her.
After showing the video to students, instructors hold a classroom
discussion about depression and suicide and make sure that students understand
the video's content.
As part of the program, students also complete the seven-item Brief Screen
for Adolescent Depression. Students with certain scores or those who answer"
yes" to questions about having suicidal thoughts or past suicide
attempts are urged to talk immediately to a school official, whether a
teacher, nurse, or school counselor.
Along with screening materials and videos, Screening for Mental Health
sends schools a procedural guide designed to help with implementation of the
SOS program—including a template for school staff on how to respond to
students in emotional distress—and a discussion guide, which helps
teachers answer students' questions and provide information about where to
turn if they are experiencing depressive symptoms.
Two preliminary studies show that the SOS program increases help seeking
and reduces suicidality among students.
In the first study, which appeared in the August 2003 Adolescent and
Family Health, Robert Aseltine Jr., Ph.D., collected data from 92 schools
participating in the SOS program during the 2000-01 academic year.
As part of the study, school administrators tracked the reactions of
students, parents, and teachers to the program. They also collected data on
the number of student visits to school counselors before and after
implementation of the SOS program.
Aseltine found that the average number of visits per month to the school
counselor or nurse in the year preceding implementation of the SOS program was
6.70, but the number increased to 10.63 in the month following implementation,
which represents an almost 60 percent increase in help-seeking behavior.
In another study, published in the March American Journal of Public
Health, Aseltine randomly selected 2,100 students in five high schools in
Columbus, Ga., and Hartford, Conn., to participate in the SOS program or a
Three months after the study intervention, students in both groups answered
questions about their knowledge of and attitudes about depression and suicide
and whether they attempted suicide during the preceding three months. About
3.6 percent of those who participated in the SOS program and 5.4 percent of
those in the control group reported attempting suicide.
About 360 schools are now participating in the SOS program, according to
Jacobs, who hopes to bring it to even more schools. Said Jacobs, "Now we
are working on a plan to get enough funding to offer the program to any school
that wants it. That is our goal."
"It is important to convince our youth that suicide is a tragic,
permanent solution to a temporary condition," he added.
More information about the Signs of Suicide Program is posted online