Applied Suicide Intervention Skills Training (ASIST) is a two-day interactive workshop in suicide first aid. ASIST teaches participants to recognize when someone may have thoughts of suicide and work with them to create a plan that will support their immediate safety. Although ASIST is widely used by healthcare providers, participants don’t need any formal training to attend the workshop—anyone 16 or older can learn and use the ASIST model.
Since its development in 1983, ASIST has received regular updates to reflect improvements in knowledge and practice, and over 1,000,000 people have taken the workshop. Studies show that the ASIST method helps reduce suicidal feelings in those at risk and is a cost-effective way to help address the problem of suicide.
Learning goals and objectives
Over the course of their two-day workshop, ASIST participants learn to:
- Understand the ways that personal and societal attitudes affect views on suicide and interventions
- Provide guidance and suicide first aid to a person at risk in ways that meet their individual safety needs
- Identify the key elements of an effective suicide safety plan and the actions required to implement it
- Appreciate the value of improving and integrating suicide prevention resources in the community at large
- Recognize other important aspects of suicide prevention including life-promotion and self-care
- Presentations and guidance from two LivingWorks registered trainers
- A scientifically proven intervention model
- Powerful audiovisual learning aids
- Group discussions
- Skills practice and development
- A balance of challenge and safety
Suicide is a Wicked Problem
Suicide is a wicked problem because it kills and injures millions of people each year, it is a complex behavior with many contributing factors, and it can be difficult to prevent. 1.1 One million people die by suicide each year An estimated one million people died by suicide in 2000; over 100,000 of those who died were adolescents (World Health Organization, 2009). If current trends continue, over 1.5 million people are expected to die by suicide in the year 2020 (Bertolote & Fleischmann, 2002). The world wide suicide rate is estimated to be 16 deaths per 100,000 people per year (World Health Organization, 2009).
For every person who dies by suicide, many more make an attempt
The ratio of suicide attempts to deaths can vary depending upon age. For adolescents, there can be as many as 200 attempts for every suicide death, but for seniors there may be as few as 4 attempts for every suicide death (Berman, Jobes, & Silverman, 2006; Goldsmith, Pellmar, Kleinman, & Bunney, 2002). A recent household survey conducted in the United States estimated that 8.3 million adults had serious thoughts about suicide in the past year, that 2.3 million had made a suicide plan, and 1.1 million had attempted suicide (Substance Abuse and Mental Health Services Administration Office of Applied Studies, 2009). A survey of Australian adults conducted by the World Health Organization found that 4.2% of respondents had attempted suicide at least once during their lifetime (De Leo, Cerin, Spathonis, & Burgis, 2005).
The devastation of suicide affects many
Suicide is devastating. Not only for those who suffer, are injured, and die from it, but also for their family, friends, and others. The total devastation of suicide is perhaps best summarized by a quote from Kay Redfield Jamison:
Suicide is a particularly awful way to die: the mental suffering leading up to it is usually prolonged, intense, and unpalliated. There is no morphine equivalent to ease the acute pain, and death not uncommonly is violent and grisly. The suffering of the suicidal is private and inexpressible, leaving family members, friends, and colleagues to deal with an almost unfathomable kind of loss, as well as guilt. Suicide carries in its aftermath a level of confusion and devastation that is, for the most part, beyond description (Jamison, 1999, p. 24).
- ASIST info sheet (PDF / 3.9 MB)
- ASIST and the NAASP clinical workforce guidelines (PDF / 257 KB)
- Evidence in Support of the ASIST 11 Program (PDF / 172 KB)
- ASIST Experiences and Recommendations (PDF / 989 KB)
- Review of ASIST (PDF / 1.8 MB)
- The Use and Impact of ASIST in Scotland (PDF / 1.5 MB)
- Gould Study Summary (PDF / 1.9 MB)
- Review of the Operation Life Suicide Awareness Workshops (PDF / 2.4 MB)
- Evaluation of the Scottish safeTALK pilot (PDF / 351 KB)
- safeTALK Manitoba Evaluation Highlights Report (PDF / 122 KB)
- SafeTALK Manitoba Evaluation Full Report (PDF / 1.5 MB)
Here is NASP Position Statement on the Netflix series “13 Reasons Why”. I think that it is important to be careful with the information and discussions we have around suicide. This position statement is worth reading.
Guidance for Educators
- While we do not recommend that all students view this series, it can be appreciated as an opportunity to better understand young people’s experiences, thoughts, and feelings. Children and youth who view this series will need supportive adults to process it. Take this opportunity to both prevent the risk of harm and identify ongoing social and behavior problems in the school community that may need to be addressed.
- Help students articulate their perceptions when viewing controversial content, such as 13 Reasons Why. The difficult issues portrayed do occur in schools and communities, and it is important for adults to listen, take adolescents’ concerns seriously, and be willing to offer to help.
- Reinforce that school-employed mental health professionals are available to help. Emphasize that the behavior of the second counselor in the series is understood by virtually all school-employed mental health professionals as inappropriate. It is important that all school-employed mental health professionals receive training in suicide risk assessment.
- Make sure parents, teachers, and students are aware of suicide risk warning signs. Always take warning signs seriously, and never promise to keep them secret. Establish a confidential reporting mechanism for students.Common signs include:
- Suicide threats, both direct (“I am going to kill myself.” “I need life to stop.”) and indirect (“I need it to stop.” “I wish I could fall asleep and never wake up.”). Threats can be verbal or written, and they are often found in online postings.
- Giving away prized possessions.
- Preoccupation with death in conversation, writing, drawing, and social media.
- Changes in behavior, appearance/hygiene, thoughts, and/or feelings. This can include someone who is typically sad who suddenly becomes extremely happy.
- Emotional distress.
- Students who feel suicidal are not likely to seek help directly; however, parents, school personnel, and peers can recognize the warning signs and take immediate action to keep the youth safe. When a student gives signs that they may be considering suicide, take the following actions.
- Remain calm, be nonjudgmental, and listen. Strive to understand the intolerable emotional pain that has resulted in suicidal thoughts.
- Avoid statements that might be perceived as minimizing the student’s emotional pain (e.g., “You need to move on.” or “You should get over it.”).
- Ask the student directly if they are thinking about suicide (i.e., “Are you thinking of suicide?”).
- Focus on your concern for their well-being and avoid being accusatory.
- Reassure the student that there is help and they will not feel like this forever.
- Provide constant supervision. Do not leave the student alone.
- Without putting yourself in danger, remove means for self-harm, including any weapons the person might find.
- Get help. Never agree to keep a student’s suicidal thoughts a secret. Instead, school staff should take the student to a school-employed mental health professional. Parents should seek help from school or community mental health resources. Students should tell an appropriate caregiving adult, such as a school psychologist, administrator, parent, or teacher.
- School or district officials should determine how to handle memorials after a student has died. Promote memorials that benefit others (e.g., donations for a suicide prevention program) and activities that foster a sense of hope and encourage positive action. The memorial should not glorify, highlight, or accentuate the individual’s death. It may lead to imitative behaviors or a suicide contagion (Brock et al., 2016).
- Reinforcing resiliency factors can lessen the potential of risk factors that lead to suicidal ideation and behaviors. Once a child or adolescent is considered at risk, schools, families, and friends should work to build these factors in and around the youth.
- Family support and cohesion, including good communication.
- Peer support and close social networks.
- School and community connectedness.
- Cultural or religious beliefs that discourage suicide and promote healthy living.
- Adaptive coping and problem-solving skills, including conflict resolution.
- General life satisfaction, good self-esteem, and a sense of purpose.
- Easy access to effective medical and mental health resources.
- Strive to ensure that all student spaces on campus are monitored and that the school environment is truly safe, supportive, and free of bullying.
- If additional guidance is needed, ask for support from your building- or district-level crisis team. The team may be able to assist with addressing unique situations affecting your building.
See Preventing Suicide: Guidelines for Administrators and Crisis Teams for additional guidance.
Suicide Awareness Voices of Education (SAVE) and the JED Foundation have created talking points for conversations with youth specific to the 13 Reasons Why series, available online.
Guidance for Families
- Ask your child if they have heard or seen the series 13 Reasons Why. While we don’t recommend that they be encouraged to view the series, do tell them you want to watch it, with them or to catch up, and discuss their thoughts.
- If they exhibit any of the warning signs above, don’t be afraid to ask if they have thought about suicide or if someone is hurting them. Raising the issue of suicide does not increase the risk or plant the idea. On the contrary, it creates the opportunity to offer help.
- Ask your child if they think any of their friends or classmates exhibit warning signs. Talk with them about how to seek help for their friend or classmate. Guide them on how to respond when they see or hear any of the warning signs.
- Listen to your children’s comments without judgment. Doing so requires that you fully concentrate, understand, respond, and then remember what is being said. Put your own agenda aside.
- Get help from a school-employed or community-based mental health professional if you are concerned for your child’s safety or the safety of one of their peers.
See Preventing Youth Suicide Brief Facts (also available in Spanish) and Preventing Youth Suicide: Tips or Parents and Educators for additional information.
Safe Messaging for Students
- Suicide is never a solution. It is an irreversible choice regarding a temporary problem. There is help. If you are struggling with thoughts of suicide or know someone who is, talk to a trusted adult, call 1-800-273-TALK (8255), or text “START” to 741741.
- Don’t be afraid to talk to your friends about how they feel and let them know you care about them.
- Be an “upstander” and take actions to reduce bullying and increase positive connections among others. Report concerns.
- Never promise to keep secret behaviors that represent a danger toward another person.
- Suicide is preventable. People considering suicide typically say something or do something that is a warning sign. Always take warning signs seriously and know the warning signs.
- Suicide threats, both direct (“I am going to kill myself.”) and indirect (“I wish I could fall asleep and never wake up.”). Can be verbal, written, or posted online.
- Suicide notes and planning, including online postings.
- Preoccupation with death in conversation, writing, drawing, and social media.
- Changes in behavior, appearance/hygiene, thoughts, and/or feelings.
- Emotional distress.
- Separate myths and facts.
- MYTH: Talking about suicide will make someone want to commit suicide who has never thought about it before. FACT: There is no evidence to suggest that talking about suicide plants the idea. Talking with your friend about how they feel and letting them know that you care about them is important. This is the first step in getting your friend help.
- MYTH: People who struggle with depression or other mental illness are just weak. FACT: Depression and other mental illnesses are serious health conditions and are treatable.
- MYTH: People who talk about suicide won’t really do it. FACT: People, particularly young people who are thinking about suicide, typically demonstrate warning signs. Always take these warning signs seriously.
- Never leave the person alone; seek out a trusted adult immediately. School-employed mental health professionals like your school psychologist are trusted sources of help.
- Work with other students and the adults in the school if you want to develop a memorial for someone who has committed suicide. Although decorating a student’s locker, creating a memorial social media page, or other similar activities are quick ways to remember the student who has died, they may influence others to imitate or have thoughts of wanting to die as well. It is recommended that schools develop memorial activities that encourage hope and promote positive outcomes for others (e.g., suicide prevention programs).
Read these helpful points from SAVE.org and the JED Foundation to further understand how 13 Reasons Why dramatizes situations and the realities of suicide. See Save a Friend: Tips for Teens to Prevent Suicide for additional information.
- Center for Disease Control Suicide Datasheet
- SAMHSA Prevention Suicide: A Toolkit for High Schools
- Suicide Prevention Resource Center, After a Suicide: Toolkit for Schools
- Memorials: Special Considerations for Memorializing an Incident
- National Association of School Psychologists, www.nasponline.org
- American Association of Suicidology, www.suicidology.org
- Suicide Awareness Voices of Education, www.save.org
- American Foundation for Suicide Prevention, https://afsp.org/
- Rape, Abuse & Incest National Network, www.rainn.org
Brock, S. E., Nickerson, A. B., Louvar Reeves, M. A., Conolly, S., Jimerson, S., Pesce, R, & Lazarro, B. (2016). School crisis prevention and intervention: The PREPaRE model (2nd ed.). Bethesda, MD: National Association of School Psychologists.
Contributors: Christina Conolly, Kathy Cowan, Peter Faustino, Ben Fernandez, Stephen Brock, Melissa Reeves, Rich Lieberman
© 2017, National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814, 301-657-0270, http://www.nasponline.org
Document may be adapted or excerpted with proper acknowledgement. Please cite as:
National Association of School Psychologists. (2017). 13 Reasons Why Netflix series: Considerations for educators [handout]. Bethesda, MD: Author.
Save a Friend: Tips for Teens to Prevent Youth Suicide
Share this handout with teens on how to prevent suicide among their peers.
Preventing Youth Suicide: Brief Facts and Tips
Share this handout with basic information on warning signs and prevention measures for youth suicide.
Preventing Youth Suicide: Tips for Parents and Educators
Parents and teachers are in a key position to identify warning signs and get youth the help they need.
Suicide is a major public health concern. Over 41,000 people die by suicide each year in the United States. More than twice as many people die by suicide each year than by homicide . Suicide is tragic. But it is often preventable. Knowing the risk factors for suicide and who is at risk can help reduce the suicide rate.
Who is at risk for suicide?
Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk for suicide. But people most at risk tend to share certain characteristics. The main risk factors for suicide are:
- Depression, other mental disorders, or substance abuse disorder
- A prior suicide attempt
- Family history of a mental disorder or substance abuse
- Family history of suicide
- Family violence, including physical or sexual abuse
- Having guns or other firearms in the home
- Incarceration, being in prison or jail
- Being exposed to others’ suicidal behavior, such as that of family members, peers, or media figures.
The risk for suicidal behavior is complex. Research suggests that people who attempt suicide differ from others in many aspects of how they think, react to events, and make decisions. There are differences in aspects of memory, attention, planning, and emotion, for example. These differences often occur along with disorders like depression, substance use, anxiety, and psychosis. Sometimes suicidal behavior is triggered by events such as personal loss or violence.
In order to be able to detect those at risk and prevent suicide, it is crucial that we understand the role of both long-term factors—such as experiences in childhood—and more immediate factors like mental health and recent life events. Researchers are also looking at how genes can either increase risk or make someone more resilient to loss and hardships.
Many people have some of these risk factors but do not attempt suicide. Suicide is not a normal response to stress. It is however, a sign of extreme distress, not a harmless bid for attention.
Source: NIMH Suicide Prevention
Jane Pearson on Warning Signs for Childhood Suicide
It’s a question asked by parents, educators and health professionals. How do we prevent suicide among our children? In this special podcast series devoted to Children’s Mental Health Awareness Day, Dr. Jane Pearson of the National Institute of Mental Health talks about important warning signs that come from children. She also looks at how well-intended reaction to tragedy can have unintended consequences. Dr. Pearson is with the Division of Services and Intervention Research at NIMH and a leading expert on suicide research.
Talking to Kids about Suicide
Things to consider around suicide
PowerPoint on Suicide– Take time to go through this is a great resource.
If you are in crisis
Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential.http://www.suicidepreventionlifeline.org