Key Learning Points

• We can all play a role in supporting students’ mental health.
• By knowing the signs of suicide risk and understanding the needs of a person at risk of suicide, we can support others.
• Conversations about suicide are never comfortable, but it is possible to develop skills for talking to someone about suicide and to increase our confidence.
• There are practical steps to take in starting a conversation about suicide with another student.
• We can make a difference to a person who is thinking about suicide by knowing how to recognize the signs of distress, responding empathetically, and knowing how to refer them to campus and community resources.
• Listening without judgment is key when talking to someone who may be at risk of suicide.
• Participants are not expected to act as counsellors and should not attempt to diagnose a person’s mental health problems.
• Participants need to be aware of their own boundaries and need for self-care. If they are overwhelmed by the session, they may want to talk to a counsellor.

Consider Who Is Attending the Session

• Will there be international students in the session or students who work with international students?
• Are there specific cultural differences to consider? For example, in some cultures, such as South Asian cultures, mental illness is still stigmatized, and students may be uncomfortable talking about it. A helpful resource on South Asian students and mental health is South Asian Mental Health (SOCH) website. SOCH was one of the producers of The Pardesi Project, a film on the mental health of South Asian international students.

Know the Procedures and Contacts at Your Campus and in Your Community

Preparing for In-Person and Online Sessions: Practical Considerations

• Before giving a session, read through the Guidelines and Tips for Facilitation section and reflect on your own experiences and feelings about suicide.
• Download the slide deck and make any needed modifications.
• Read through the facilitator’s guide and handouts to familiarize yourself with the content. You may want to download the guide as a PDF file and print it.
• Consider sending participants a link to the video on the Live Through This website to give them a chance to hear suicide survivors’ stories before the training. Alternatively, you could show the video during the session, or bookmark the video and have it ready to play in a browser before the session.
• Prepare to give a territory acknowledgement to open the session. Also consider ways in which to Indigenize the content. (See Indigenous Considerations.)
• Read through the scenarios and think about which scenarios you want students to discuss. There are 10 scenarios to choose from, but it’s unlikely you’ll have time to cover them all. Handout 2.1 has just the scenarios, with no responses; Handout 2.2 has the scenarios with suggested responses.
• Consider how many participants you expect to attend. The facilitator’s guide assumes a small to medium number of participants (approximately 6 to 30); if your group is very large, you may need to modify some of the small group and reflection activities.
• Add relevant examples and additional insights that are based on your own experience or are relevant to the student population at your institution.
• Prepare the handouts. Either have them ready to hand out for an in-person session or have the links to the PDFs ready for an online session. Determine how you will share handouts and other resources, particularly when you are facilitating an online session. You can put PDFs in the chat, share a link in the chat, or email participants after the session.
• Have your institution’s workshop evaluation form ready to give to participants after the session.
• Consider providing participants with group guidelines before the session so people can prepare and create guidelines together. This will save time during the session. See Group Guidelines for more information.

Preparing for an In-Person Session

• Laptop
• Projector
• Flipchart or whiteboard and markers
• Copies of Handouts 1, 2.1, 2.2, and 3

Support for participants who get overwhelmed during an in-person session

Preparing for an Online Session

• Schedule a meeting time in your post-secondary institution’s preferred video-conferencing platform.
• Make sure that the screen-share function is enabled for sharing slides.
• If you will be using the chat or breakout rooms, make sure they are enabled.
• Share the meeting link and any passwords with participants before the session. (Consider sending the meeting information at least twice, including once the day before the session.)
• You may also want to share suggestions for online meeting etiquette for creating a safe learning space (e.g., sharing supportive comments, respecting confidentiality).
• Consider assigning someone to be the monitor responsible for responding to technical issues and questions posted in the chat.
• As noted above, make sure you have a plan for distributing any resources, such as the handouts, online. Remember to let participants know how and when they can expect to receive these resources.

Support for participants who get overwhelmed during an online session

Working in small groups online

Territory Acknowledgement

Curriculum Development and Indigenous Ways of Knowing and Being

• Incorporate Indigenous pedagogical approaches, such as holistic and relational perspectives, experiential learning, place-based learning, and intergenerational learning.
• Involve Indigenous students, faculty, and staff in reviewing, adapting, and evaluating resources.
• Integrate knowledge from Indigenous communities local to your institution.

• How does this work benefit Indigenous communities and help them to meet their goals?
• Will there be benefits for Indigenous students, faculty, and staff?
• Have the community or communities identified their own priorities or goals related to this work?
• How can this work support Indigenous efforts related to healing from past and ongoing colonial violence?

Elders and Knowledge Keepers

• This chapter is adapted from Consent & Sexualized Violence Training and Facilitator Guide: Preventing and Responding to Sexual Violence in B.C. Post-Secondary Institutions, Sexual Violence Training Development Team (CC BY 4.0 License).

Creating a Safe Learning Space

Opening with Intention

Scope of the Session

Group Guidelines

• Share the learning, not the names or the stories (confidentiality).
• Participants have the right to “pass” on activities/questions that feel uncomfortable.
• It is all right to feel uncomfortable or to not know answers to everything.
• It is okay to step out of the session at any time.
• Treat others with respect.
• Be mindful of your language; respect everyone’s names and pronouns.
• Remember that there may be participants in the session who know someone who has either attempted suicide or died by suicide, and there may be participants who have attempted suicide or are having thoughts of suicide. The session may bring up strong emotions for them.
• Speak for yourself. Use “I statements” to state opinions or feelings.
• Seek to replace judgment with curiosity.
• Take care of yourself.
• Take space, make space (allow everyone a chance to participate).

Content Warnings

Content warnings (also called trigger warnings) are statements made before sharing potentially difficult or challenging material. The intent of content warnings is to provide participants with the opportunity to prepare themselves emotionally for engaging with the topic or to make a choice to not participate.

We will be discussing topics related to suicide in this training. During the training, you can choose not to participate in certain activities or discussions and can leave the room at any time. If you feel upset or overwhelmed, please know that there are resources to support you.

There are a number of other facilitation strategies you may want to consider in addition to or instead of a content warning:

• When discussing difficult content, check in with participants from time to time. Ask them how they are doing, whether they need a break, and so on. Let them know that you are aware that the content is difficult.
• Ask participants to be mindful of their fellow learners during the discussion and remind them that survivors of suicide may be present in the room (regardless of whether this information has been shared with others).

Trauma Awareness

Before the Session

To Start

During the Session

After the Session

Questions That May Come Up and How to Respond

Transitions and Difficult Conversations

• “This is a really great dialogue, but I would like to bring us back to the topic at hand.”
• “Thank you for sharing that story. I’d like to follow up with you after the session today if we can save this conversation for later.”
• “I’m getting conscious of time here. Let’s move on for now.”
• “Your feelings are important and I want to be able to give you my full attention. Would you like to step out and have a conversation about it? My colleague can continue with the session.” (This can work if there are two co-facilitators. If there is only one facilitator, you can suggest continuing the conversation after the session.)
• “We’re not here today to argue about the ethics or morality of suicide. We want to focus on questions, feelings, worries, and thoughts people might have about supporting someone who is at risk of suicide.”
• “It’s okay for us to agree to disagree. Let’s move on; I’d like to bring us back to some of the activities and questions we had planned.”

A Note About Language

Self-Care and Community Care

Check-In/Reflection Questions for Facilitators

• What was a positive moment or a success in this session?
• How did participants engage with the different activities? Is there something I want to facilitate or do differently next time?
• Did I or a participant seem to have a response to the material, a shared story, or another participant that was challenging? If so, how was it responded to or resolved?
• Is there something that would be helpful for me to learn about or check with a colleague about?

Resources on Suicide for Further Reading and Preparation

• Canadian Association for Suicide Prevention: Provides information and resources to communities to reduce the suicide rate and minimize the harmful consequences of suicidal behaviour.
• Centre for Addiction and Mental Health (CAMH): Has many resources around suicide awareness, including a Get Help page with information on crisis lines and immediate help.
• Centre for Suicide Prevention: A branch of the Canadian Mental Health Association that provides information and resources on how to respond to people at risk of suicide. Offers toolkits, information sheets, and training resources.
• HeadsUpGuys: An online resource from the University of British Columbia that supports men in their fight against depression by providing tips, tools, information about professional services, and stories of success. Supports men’s mental health in a positive, inclusive, and mutually supportive way and is for people of all backgrounds, regardless of gender, race, or sexual orientation.
• Kelty Mental Health Resource Centre, B.C. Children’s Hospital: Provides mental health and substance use information, resources, and peer support for youth and young adults. Also provides information and resources for people of all ages with an eating disorder or disordered eating concern.
• LifeLine Canada App: A free suicide prevention and awareness app that offers access to support and guidance for people in crisis and people who have suffered the devastating loss of a loved one from suicide.
• Live Through This: A website with a collection of personal stories from people who have attempted suicide and survived. The diverse voices illustrate that suicide can affect anyone, and reading some of these stories is a helpful way to prepare for the session.
• LivingWorks ASIST Suicide Prevention Training Program: Offers workshops on how to prevent suicide by recognizing signs, how to provide a skilled intervention, and how to develop a safety plan.
• Mental Health Commission of Canada: Offers a number of fact sheets, research reports, and webinars on suicide prevention.
• Self-Injury Outreach and Support: A non-profit outreach initiative providing information and resources about self-injury to those who self-injure, those who have recovered, and those who want to help.
• South Asian Mental Health (SOCH): A mental health promotion initiative tailored to provide the South Asian community with mental health support and start the conversation to break the stigma around mental health. The Pardesi Project, a film about the mental health of South Asian international students, is available on their website.
• The Trevor Project – Saving Young LGBTQ Lives: The world’s largest suicide prevention and crisis intervention organization for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) young people.
• We Matter Campaign: An Indigenous, youth-led, nationally registered organization dedicated to Indigenous youth support, hope, and life promotion.

Text Attributions

• “Creating a Safe Learning Space,” “Trauma Awareness,” and “Self-Care and Community Care” are adapted from Consent & Sexualized Violence Training and Facilitator Guide: Preventing and Responding to Sexual Violence in B.C. Post-Secondary Institutions, Sexual Violence Training Development Team (CC BY 4.0 License).

• Welcome and Territory Acknowledgement
• Introductions and Check-In
• Goals and Objectives
• Practical Information
• Self-Care When Talking About Suicide
• Group Guidelines
• Reflection: Assessing Confidence

• Activity: Myths and Commonly Misunderstood Ideas
• Looking at Statistics
• Risk Factors and Protective Factors
• Marginalized Groups
• Activity: Discussion

• Feelings and Attitudes
• Activity: Questions and Worries
• What We Need to Consider Before a Difficult Conversation

• Signs That Someone Is Contemplating Suicide
• Suicide and Self-Harm

• What Does a Person in Distress Need?
• How to Start the Conversation
• Ask Directly and Clearly About Suicide
• Consider the Risk
• Responding Online

• Asking About Supports and Suggesting Resources
• Campus Resources and Provincial Crisis Lines
• If You Are Concerned About a Student’s Immediate Safety
• If You Are Unsure What to Do
• What About Social Media?
• Scenario Walk-Through
• What Helps People Recover?

• Recognize What You Can and Can’t Do
• Remember FAIR to Help Maintain Boundaries
• Self-Care After a Difficult Conversation

• Activity: Practice Scenarios (10 scenarios to choose from)

• Reassessing Your Confidence
• Reflection, Questions, and Comments
• Activity: Brainstorming Self-Care Ideas

• Welcome and territory acknowledgement
• Goals and objectives
• Practical information
• Self-care for participants
• Group guidelines

Welcome and Territory Acknowledgement

Introductions and Check-In

Online

Goals and Objectives

• Explain myths and misunderstood ideas about suicide.
• Recognize the different signs indicating that someone is in distress or at risk of suicide.
• Ask if a person is considering suicide, express support, and refer the person to appropriate resources.
• Discuss roles and appropriate boundaries for participants who are responding to a student who is considering suicide.

Practical Information

• Provide feedback and share your input during the discussions, as this will increase learning opportunities for you and others.
• Jot down notes during reflection activities.
• Ask any questions you might have during the session.

Self-Care When Talking About Suicide

Adaptation To begin, you could have participants do a breathing exercise, such as the box breathing exercise described before the break.

Group Guidelines

• This is a learning environment, not a therapy group.
• Sometimes a topic like suicide brings things up for people, but what comes up in this room – whether in person or online – stays in the room.
• It’s expected that you will be non-judgmental of each other and will show extra sensitivity when engaging in discussion during the session. This session is about gaining a little more comfort and confidence in dealing with this topic.

• “Territory Acknowledgement and Indigenous Ways of Knowing and Being” by Jewell Gillies (CC BY 4.0 License).

Media Attributions

• Cedar Tree Needles by Adam Krig is licensed under a Unsplash License.
• Lake in Dome Creek, B.C. by Jakub Fryš is licensed under a CC BY-SA 4.0 License.
• Flowers and the beach by Andrey_and_Lesya is licensed under CC0 Public Domain Dedication.
• Reflections of heart by Álvaro Bueno is licensed under a CC BY 4.0 License.

Myths and Commonly Misunderstood Ideas

Activity: Talking About Myths and Misunderstood Ideas

In small groups, have participants discuss one of the myths below. You could have each group discuss a different myth and then bring their thoughts back to the larger group for a larger group discussion. Adaptation

• As a large group, ask participants to share their thoughts about the myths and give everyone an opportunity to ask questions. If the session is online, you could have participants share thoughts and ideas in chat.

You could also ask participants to consider the following questions:

• What myths or stereotypes exist in society about suicide?
• What cultural stereotypes are there about suicide?
• What questions do you have about suicide?

Looking at Statistics

• 10.1% of students had seriously considered suicide within the previous 12 months.
• 1.9% had attempted suicide within the previous 12 months.
• 6.0% intentionally cut, burned, bruised, or otherwise injured themselves within the previous 12 months.

• People with experience of abuse, trauma, conflict, or disaster, including bullying, cyberbullying, and peer victimization are at higher risk of suicide.
• Those who have been bereaved or affected by suicide in others may have a higher risk.

Risk Factors and Protective Factors

• Prior suicide attempt – If someone has attempted suicide in the past, there is an increased risk that they may try it again
• Trauma (violence, abuse, or events that affect generations of one’s family)
• Triggering life events (losing a loved one, physical illness, discrimination, harassment)
• Mental illness, such as depression
• Alcohol or drug addiction
• Chronic physical illness
• Barriers to accessing care
• Lack of support from family, friends, community
• Personal identity struggles (cultural, sexual)
• Feelings of isolation
• Systemic discrimination
• Social media

• Access to appropriate mental health services and support
• A sense of hope, purpose, belonging, and meaning
• A sense of belonging and connectedness with family, culture, community, and friends
• Supportive environments and healthy relationships
• Skill in problem solving, conflict resolution, and non-violent handling of disputes

Facilitator Note: The Tree of Life

This guide has an image of a cedar branch on the cover. Trees sustain life on earth and are a powerful symbol of growth, interconnection, resilience, and strength. The western red cedar is a particularly important tree for many Indigenous Peoples on the west coast of British Columbia. Below is one perspective on the importance of the red cedar tree to Kwakwa̱ka̱’wakw people.

In the Kwakwa̱ka̱’wakw Nation, the red cedar is known as our tree of life. This tree expresses our responsibility as stewards of the land. The roots of a red cedar tree go deep, and when they are connected to other trees, they can share natural resources to support the health of the forest communally. Ever since the Kwakwa̱ka̱’wakw people came into existence thousands of years ago, from our birth to the ceremony mourning our passing as individuals, the tree of life has played – and continues to play – a crucial role in every aspect of our lives. Kwakwa̱ka̱’wakw people have sacred teachings on sustainably harvesting the bark of red cedars for our regalia, our woven cedar hats, or our headbands; this regalia plays a vital role in our Potlatch ceremonies. The tree of life is often in our artwork, our regalia; it represents the spirit of hope our communities have for our families, our communities, and the other nations interconnected with ours. The connection between our traditional teachings and protocols around red cedars is very similar to how we support people in mental health distress. A sense of connection, community, dignity, and respect are essential. So much of a tree’s determinants of health lie within the soil, a place we cannot see. When supporting a student who is very distressed and possibly considering suicide, it is important to remember all of the protective factors they may have below the surface:

• Counselling support
• Family and friends
• Community supports
• Spiritual or religious beliefs or practices

Our role in supporting others with suicidal ideation is to determine the most appropriate resources to help them, in the same way as the roots of the tree of life share their resources with the forest around them.

—Jewell Gillies, Musgamagw Dzawada’enuxw of the Kwakwa̱ka̱’wakw Nation (Ukwana’lis, Kingcome Inlet, B.C.)

Marginalized Groups

Indigenous Students

International Students

LGBTQ2S+ Students

Students with a Disability

Racialized Students

What We Need to Keep in Mind

Text Attributions

• “Risk Factors and Protective Factors” and “Marginalized Groups” by Barbara Johnston. “The Tree of Life” by Jewell Gilles (CC BY 4.0 License).

Media Attributions

• What Is Live Through This by Dese’Rae L. Stage, Live Through This Productions, is licensed under a Standard YouTube License.
• Cedar tree by anonymous is licensed under CC0 Public Domain Dedication.
• Iceberg in the Arctic with underside exposed by AWeith is licensed under a CC BY-SA 4.0 License.
• Silhouette by anonymous is licensed under CC0 Public Domain.

Feelings and Attitudes

Activity: Questions and Worries

Ask participants to divide up into pairs to discuss these questions: Imagine that you are able to ask someone if they are thinking about suicide. What questions, thoughts, beliefs, worries, feelings come up for you? What are your worst fears? Then, as a large group, ask people to share their responses. (If the session is online, participants could share their responses in the chat.) Responses may include:

• I’d be afraid that my asking them would make them start thinking about it more.
• It’s so much responsibility.
• I don’t have time to deal with the issue fully.
• I won’t know what to do if they are considering suicide – what next?
• What if it’s insulting to my classmate/friend?

Adaptations You could also ask participants to think about their own beliefs and ideas about who does or does not end their own life. For example, a person may assume that seemingly in-control people are not at risk of suicide. Or perhaps they hold stereotypes or have ideas about specific groups of people and suicide. This is a good opportunity to explore any biases.

What We Need to Consider Before a Difficult Conversation

• Given my own history and background and current life events, is this the best time for me to have this conversation with someone?
• Am I able to ground myself?
• Do I need to find a way to pass the conversation to someone else (knowing that it’s okay to do so)?

• Create an atmosphere and environment of non-judgment and openness.
• Consider any possible triggers.
• Consider risk factors.
• Ensure that you are in a private space where you will not be interrupted and can minimize distractions (e.g., your phone is turned off).
• Be compassionate.
• Be patient.
• Be hopeful.

Media Attributions

• Person writing on white paper by NeONBRAND is licensed under a Unsplash License.
• Wooden path through forest by Michal Kulesza is licensed under CC0 Public Domain Dedication.
• reflections of heart by Álvaro Bueno is licensed under a CC BY 4.0 License.

Contributors

Advisory Group Members

Post-Secondary Institutions

BCcampus

Ministry of Advanced Education and Skills Training

Student Authors

Antoine, A., Mason, R., Mason, R., Palahicky, S., & Rodriguez, C. (2018). Pulling together: A Guide for Indigenization of post-secondary institutions. A professional learning series. https://opentextbc.ca/indigenizationcurriculumdevelopers/

Bauer, G., Schiem, A., Travers, R., & Hammond, R., (2015). Intervenable factors associated with suicide risk in transgender persons: A respondent driven suicide risk sampling study in Ontario, Canada. BMC Public Health, 15, 525. DOI: 10.1186/s12889-015-1867–2

Buddy Up. (n.d.). The gender paradox. https://www.buddyup.ca/learn/

Canadian Association for Suicide Prevention. (n.d.). I’m concerned about someone. https://suicideprevention.ca/im-concerned-about-someone

Canadian Mental Health Association. (2016). Preventing suicide. https://cmha.ca/documents/ preventing-suicide

Centre for Suicide Prevention. (n.d.). Fact sheet: Sexual minorities and suicide prevention. https://www.suicideinfo.ca/resource/sexual-minorities-suicide-prevention/

Centre for Suicide Prevention. (n.d.). Fact sheet: Transgender people and suicide. https://www.suicideinfo.ca/resource/trans-fact-sheet/

Centre for Suicide Prevention. (n.d.). Indigenous people, trauma, and suicide prevention [toolkit]. https://www.suicideinfo.ca/resource/trauma-and-suicide-in-indigenous-people/

Centre for Suicide Prevention. (n.d.). Sexual minorities and suicide [toolkit]. https://www.suicideinfo.ca/resource/sexual-minorities-suicide-prevention/

Haas, A., Eliason, M., Mays, V., Mathy, R., Cochran, S., D’Augelli, A., Silverman, M., Fisher, P., Hughes, T., Rosario, M., Russell, S., Malley, E., Reed, J., Litts, D. A., Haller, E., Sell, R. L., Remafed, G., Bradford, J., Beautrais, A. L., Clayton, P. J. (2011). Suicide and suicide risk in lesbian, gay, bisexual and transgender populations: Review and recommendations. Journal of Homosexuality, 58(1), 10–51. DOI: 10.1080/ 00918369.2011.534038

Irwin, J., Coleman, J., Fisher, C., & Marasco, V. (2014). Correlates of suicide ideation among LGBT Nebraskans. Journal of Homosexuality, 61(8), 1172–1191.

Kirmayer, L. J., Brass, G. M., Holton, T., Paul, K., Simpson, C., & Tait, C. (2007). Suicide among Aboriginal people in Canada. Aboriginal Healing Foundation.

Kumar, M. B., & Tjepkema, M. (2019, June 28). Suicide among First Nations people, Métis and Inuit (2011–2016): Findings from the 2011 Canadian Census Health and Environment Cohort (CanCHEC). Statistics Canada. https://www150.statcan.gc.ca/n1/pub/99-011-x/99-011-x2019001-eng.htm

Little Bear, L. (2009). Naturalizing Indigenous knowledge: Synthesis paper. Canadian Council on Learning. https://www.afn.ca/uploads/files/education/21._2009_july_ccl-alkc_leroy_littlebear_naturalizing_indigenous_knowledge-report.pdf

McNeill, J., Ellis, S. J., & Eccles, F. J. R. (2017). Suicide in trans populations: A systematic review of prevalence and correlates. Psychology of Sexual Orientation and Gender Diversity, 4(3) 341–353. https://doi.org/10.1037/sgd0000235

Mental Health and Wellness Advisory Groups. (2020). Framework for evaluating mental health and wellness education and training resources. BCcampus. https://opentextbc.ca/ mhwframework/

Moore, K. (2019). Mental health collaborative project, student resilience and coping training workshops: Environmental scan. BCcampus. https://bccampus.ca/wp-content/uploads/2020/06/Student-Report.pdf

Seibel, D. K., Katsamakis, A., Stuart, A., Mochizuiki, T., Hagerty, M., & Seibel, L. M. (2020). Final report: Evaluation of resources for mental health and wellness training in the post-secondary context (students, staff, and faculty), Phase one. BCcampus. https://bccampus.ca/wp-content/uploads/2021/02/FINAL-Mental-Health-Wellness-Final-Report_Final.pdf

Sexual Violence Training Development Team. (2021). Consent and sexualized violence: Training and facilitator guide – Preventing and responding to sexual violence in B.C. post-secondary institutions. BCcampus. https://opentextbc.ca/svmconsent/

Stage, D. L. (2010). Live through this. https://livethroughthis.org

Statistics Canada. (2019, July 22). Suicide in Canada. https://www.canada.ca/en/public-health/ services/suicide-prevention/suicide-canada.html

Suicide Prevention Resource Center. (2008). Suicide risk and prevention in gay, lesbian, bisexual and transgender youth. Education Development Center, Inc. http://www.sprc.org/sites/default/files/migrate/library/SPRC_LGBT_Youth.pdf

Turpel-Lafond, M. E. (2020). In plain sight: Addressing Indigenous-specific racism and discrimination in B.C. health care. https://engage.gov.bc.ca/app/uploads/sites/613/2021/02/In-Plain-Sight-Data-Report_Dec2020.pdf1_.pdf

U.S. Office of Disease Prevention and Health Promotion. (n.d.). Lesbian, gay, bisexual, and transgender health. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

World Health Organization. (2019). Suicide [fact sheet]. https://www.who.int/news-room/fact-sheets/detail/suicide

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Other File Formats Available

Known Accessibility Issues and Areas for Improvement

Accessibility Standards

How to Access the Facilitator’s Guide, Slides, and Handouts

• Handout 1: Quick Reference: Responding to Students in Crisis
• Handout 2.1: Scenarios for Practice and Discussion (no responses)
• Handout 2.2: Scenarios and Responses
• Handout 3: Suicide Awareness Resources

• Live Through This (4:15 min.)
• Brené Brown on Empathy (2:53 min.)

How to Use This Resource

• Facilitator’s guide. The guide includes presentation notes, activities, and scenarios to help you deliver the training. You can download the guide as a PDF file before giving a session. The guide also has a Getting Ready section, with suggestions for preparing, adapting, and modifying the training.
• Slide deck. The guide has an accompanying PowerPoint slide deck that you can download. The slides can be formatted to meet your institution’s guidelines or slide deck templates. You can add slides or include contact information for counselling services, campus helplines, Indigenous student centres, and other services on your campus that support students.
• Handouts. The guide includes handouts that you can share with participants. You can format these handouts according to your institution’s guidelines (e.g., colours, fonts, logos). You can also adapt the information in them to reflect the needs and concerns of the group you are addressing.

Who Should Facilitate This Training?

Who Is This Training For?

Length of the Session

Creative Commons License

Attribution Statement

Why Mental Health and Wellness Training for Students?

Signs That Someone Is Contemplating Suicide

• You already have these skills.
• Noticing the signs is the starting point.

Thoughts

• I can’t do anything right.
• I just can’t take it anymore.
• I can’t carry on like this.
• I wish I were dead.
• People will be better off without me.
• No one can do anything to help me.

Feelings

Statements

• “I’m going to end it all.”
• “I’d be better off dead.”
• “If X happens (or doesn’t) I’m going to kill myself.”

• “Everyone would be better off without me.”
• “My life has no purpose. I’ve lost hope.”
• “Nothing will ever change and I give up.”
• “I can’t do this anymore.”

Physical Signs

• Lack of interest in appearance and hygiene
• Sleep disturbances
• Change in weight or loss of appetite
• Physical health complaints

Stressful Events or Loss

• Academic failure
• Recent relationship breakup
• Financial instability
• Other suicides on or off campus
• Depression or other mental illness (although people who do not have mental illness can have thoughts of suicide)
• Family history of mental health events
• Humiliation, bullying, or harassment
• Recent death of family member or friend
• Anniversary date of the death of a family member or friend
• Critical health diagnosis or injury

Actions

• Withdrawing
• Loss of interest in favourite activities
• Misuse of drugs or alcohol
• Reckless behaviour
• Extreme behavioural changes
• Impulsivity
• Self-harm

Suicide and Self-Harm

When There Are No Signs

Media Attributions

• Wooden path through forest by Michal Kulesza is licensed under CC0 Public Domain Dedication.

• Trust yourself. Believe your suspicions and be aware.
• The aim is to connect someone who is having thoughts of suicide with other supports.
• Remember: If someone is in distress, you will not increase the risk of the person taking their own life by asking if they are thinking of suicide.

What Does a Person in Distress Need?

What Else Can Help?

• Approach with concerned care.
• Understand with empathy.
• Recognize and relate with kindness.
• Ask with respect.
• Lead with hope.
• Introduce help with community.

Adaptations

How to Start the Conversation

• “I noticed that you’re not hanging out with us anymore. I wondered how things were going.”
• “I noticed that you stopped coming to class. I wanted to see how you’re doing.”
• “I can see you’re really overwhelmed. I wanted to check in.”

• “I've noticed you’ve been really quiet lately. That’s not like you. Is everything okay?”
• “I wonder if what’s happening at school these days is stressing you out.”
• ”With everything that’s going on in your family, I wonder if you’re feeling overwhelmed.”

Ask Directly and Clearly About Suicide

• “At this point, I need to ask you something. Are you feeling so bad that you’re considering suicide?”
• “I might be way off base, but when you said there is no point in continuing, I wondered what you meant…”
• “That sounds like a lot for one person to take. Has it made you think about killing yourself to escape?”

• “Has all that pain you’re going through made you think about ending your life?”
• “I see what you are doing and how much you must be hurting. I’m concerned about you. I want to talk. I want to hear what’s going on with you.”

What Not to Say

• “Things aren’t that bad.”
• “This too shall pass.”
• “You're being so dramatic.”
• “It could be worse.”
• “You think you have it bad. A lot of people have it worse.”

What If They Say They’re Not Thinking About Suicide?

• They didn’t really mean it to come across that way.
• They have thought about it but would never act on it.
• They have many reasons to live.

What If They Say They Are Thinking of Suicide?

• Take them seriously. Let them know you feel this is important to talk about.
• Listen without judgment and give them your complete attention.
• Acknowledge their thoughts and feelings with compassion.
• Ask about their personal supports. Ask if they have other people they can talk to. Have they talked to anyone else?
• Ask them what they need to be safe.

Consider the Risk

• “How often are you thinking about this?”
• “Do you have a plan? Have you thought about how you would kill yourself?”
• “Have you thought about when?”

Responding Online

Media Attributions

• Friends Talking by Michael Coghlan is licensed under a CC BY-SA 2.0 License.
• Brené Brown on Empathy is an RSA short licensed under a Standard YouTube license. Voice: Dr Brené Brown. Animation: Katy Davis (AKA Gobblynne) www.gobblynne.com. Production and editing: Al Francis-Sears and Abi Stephenso.

Asking About Supports and Suggesting Resources

Campus Resources and Provincial Crisis Lines

• Counselling services help students manage personal, academic, and life concerns. Professional counsellors provide individual and group counselling sessions for students.
• Campus security helps coordinate responses to student emergencies and crises. If you call 911, also call campus security, as security can help first responders locate you.
• Student services offer many supports for students.
• Indigenous student centres offer support, mentorship programs, and a gathering place. Many campuses have an Elder who may be available to talk to students.
• Health or medical services offer health and mental health care for students.
• International student services help students with personal or academic issues, study and work permits, and visa applications.
• Accessible learning services provide services and coordinate academic accommodations for students.
• Pride centres provide support to LGBTQ2S+ students.
• Sexualized violence resource centres offer support for victims of sexualized violence.

Provincial Crisis and Support Lines

• B.C. Suicide Line: 1-800-784-2433 (1-800-SUICIDE) or https://crisiscentre.bc.ca/
• Mental Health Support Line: 310-6789 (no need for area code)
• Here2Talk: 1-877-857-3397 (24-hour phone and chat counselling support service for B.C. post-secondary students) Note: If you request support in a language other than English or French, Here2Talk may be able to match a student with a counsellor who can support a student in their own language (https://here2talk.ca)
• KUU-US Crisis Line: 1-800-588-8717 (1-800-KUU-US17) – provides culturally safe support, 24/7, for Indigenous people in B.C. (www.kuu-uscrisisline.com/24-hour-crisis-line)

If You Are Unsure What To Do

• You are concerned about a student’s safety or well-being but are unsure how or whether to intervene.
• You are uncertain how to respond to someone who needs help.
• You continue to be concerned about someone you know who has declined help.

If a Student Won’t See a Counsellor or Seek Help

What About Social Media?

Summary: What to Keep in Mind When Talking About Suicide

• Ask directly about suicide. Stay calm and listen.
• Acknowledge how the person is feeling and let them know you want to help.
• Ask about personal supports. Do they have other people they can talk to? Have they talked to anyone else?
• Provide information about resources. Connect them with supports or professional help.
• If something still doesn’t feel right, consult with your student centre, supervisor, campus security, or campus resources.

Scenario Walk-Through

Scenario

• Highlight support and empathy while recognizing the capacity of the other student.
• Ask about suicide.
• Suggest a referral or follow-up.

• Start with an empathetic response: “I can see that you’re upset about the exam. I can hear the disappointment in your voice and understand your fear about what will happen for you.”
• Ask directly about suicide: “I may be way off base, but when you say you say, ‘It’s not going to matter much longer anyway,’ do you mean that you are thinking about suicide? I want to support you to be safe and to have a good outcome from this challenging time.”
• Suggest a referral: “I wonder if you’d be willing to talk to a counsellor? It’s confidential and I think it’s a wise thing to do. I’d like to walk over there with you.”

What Helps People Recover?

• There is help to get through this. One step at a time. One minute at a time.
• Please reach out for help. You are not alone and you matter.
• HOPE (Hold On, Pain Ends).

• Be patient. Be hopeful.
• Always take the person seriously, even if they have expressed thoughts about suicide in the past.
• Listen, and ask them what they need to be safe.

Break

Media Attributions

• Referral Icon No Attribution by Ahkâm is licensed under CC0 Public Domain. ​
• Flower Road Crack by Leuchtturn81 is licensed under a Pixabay License.

Recognize What You Can and Can’t Do

• “I’m glad you told me…”
• “I can’t do that, but I can do this…”
• “I’m happy you chose to talk to me, and we need to talk about a transition plan because I’m not a counsellor. I’m struggling here because this is out of my depth. The best way I know how to deal with this is to talk to a counsellor.”

Remember FAIR to Help Maintain Boundaries

• Fear: You feel afraid of what a person may do to themselves or others.
• Anger: Feeling angry is a sign that you need to take a step back.
• Ignorance: You don’t know what more you can do for the person.
• Responsibility and resentment: You are starting to resent the responsibility you have taken on for the person.

Self-Care After a Difficult Conversation

• Have I let this go?
• Am I okay with this?
• Is there anything I need to do?
• Am I feeling overwhelmed and should I talk to a counsellor?

Activity: Practice Scenarios

• How might you respond and offer support to the person?
• What services might you suggest?
• Who might you consult with?
• How does it feel to imagine offering support to the student in the scenario?
• How was it to ask about suicide?

Online

Options for Scenarios

Media Attributions

• Beach, sea, coast, sand, ocean, shore, wave, material, body of water, wind wave by anonymous is licensed under CC0 Public Domain Dedication.
• Flower of an Indian Lotus by Hong Zhang is licensed under CC0 Public Domain Dedication.

Facilitator’s Guide for Use with Students

Dawn Schell, Dagmar Devine, Jewell Gillies, Jenny Guild, Arica Hsu, Hamza Islam, Barbara Johnston, Calla Smith and Liz Warwick

BCcampus

Victoria, B.C.