Returning to School Following Hospitalization for Suicide-Related Behaviors: Recognizing Student Voices for Improving Practice

Abstract

Adolescent hospitalizations for suicide-related behaviors have increased in recent years, with the highest rates occurring during the academic school year. Schools are a primary environment that adolescents return to following hospitalization, making them an important context for understanding recovery following a suicidal crisis. Although previous research highlights provider perceptions for improving this transition, limited research has focused on adolescent views. This qualitative study presents findings from interviews with 19 adolescents previously hospitalized for a suicide-related crisis. Results highlight the need to strengthen social supports for returning youth. Specifically, findings suggest the importance of emotional supports (e.g., positive school relationships and a safer psychosocial school climate), instrumental supports (e.g., collaborations and communication around reentry), informational supports (clearer procedures for academics and reentry processes), and appraisal supports that acknowledge the complexity of adolescent functioning upon return. Findings reinforce the importance of the school psychologist’s role in partnering with returning youth and their families and providing consultation to other school professionals about supporting their recovery.

Impact Statement

This study elevates adolescent voices by describing their experiences and viewpoints regarding school reintegration following psychiatric hospitalization for suicide-related behaviors. School psychologists and other school professionals should partner with returning students and families in supporting reintegration, and collaborate to strengthen student–adult relationships upon their return. While standard protocols for supporting returning adolescents may help improve reentry processes overall, it remains of critical importance to tailor safety plans and reentry plans based on individual adolescent experiences.

Keywords:

• suicide
• school adjustment
• qualitative methods
• prevention
• mental health services
• community-school collaboration

ASSOCIATE EDITOR:

• Tyler Renshaw

ACKNOWLEDGMENTS

The researchers would like to acknowledge the families who donated their time to this project and the Qualitative Science & Methods Training Program (QSMTP) of the Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, which provided training in qualitative research methods for this manuscript.

DISCLOSURE

No potential conflict of interest was reported by the authors.

Additional information

Funding

This project was supported by Grant SRG-0-093-17 awarded to Marisa E. Marraccini from the American Foundation for Suicide Prevention. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Foundation for Suicide Prevention. The project described was also supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR002489, and internal funding from the University of North Carolina (UNC) at Chapel Hill. Marisa Marraccini’s effort was supported by the National Institutes of Health, through Grant Award Number K23MH122775 (Marraccini). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or UNC.

Notes on contributors

Marisa E. Marraccini

Marisa Marraccini, PhD, is an assistant professor in the school psychology program in the School of Education at the University of North Carolina at Chapel Hill and a licensed psychologist. Her research focuses on promoting mental health in school settings with an emphasis on suicide prevention. Her work aims to integrate consideration of school context into clinical interventions and approaches to suicide prevention, and also to enhance school supports for adolescents recovering from suicidal crises.

Cari Pittleman

Cari Pittleman, MEd, is a doctoral student within the school psychology program at the University of North Carolina at Chapel Hill. In her research, Cari explores equitable access to mental health supports in both school and clinical settings. Clinically, Cari has experience working with children and adolescents with developmental disabilities, ADHD, autism, epilepsy, and brain injury. She is a former elementary classroom teacher.