b'Bullying and Suicide The relationship between bullying and suicide is highly complex, as is the relationship between suicide and othernegative life events. Research indicates that persistent bullying can lead to or worsen feelings of isolation, rejection,exclusion and despair, as well as depression and anxiety, which can contribute to suicidal behavior in those at-risk. 21 While studies have shown that young people who are bullied and those who bully others are at heightened risk for suicidal behavior, youth who exhibit both pre-existing risk for suicide (e.g., a history of depression, anxiety, substance use or other health conditions) and who are concurrently involved in bullying or experiencing other negative life events are at highest risk. 22 Individuals who are bullied in the absence of other risk factors have far fewer negative outcomes than those with pre-existing risk for suicide. Youth who bully are also at-risk, and their behavior may reflect underlying mental health problems or previous childhood trauma. One study found that those who are bullied (cyber or in person) are 19 times more likely to experience suicidal ideation than youth with no history of bullying. 23It is imperative to convey safe and accurate messages about bullying and suicide to youth, especially to youngpeople who may be at-risk for suicide. Suggesting that suicide is a natural response to bullying, or providing repeated opportunities for at-risk students to see their own experiences of bullying, isolation, or exclusion reflected in stories of those who have died by suicide, can increase contagion risk by contributing to thoughts that frame suicide as a viable solution. Idealizing young people who complete suicide after being bullied orcreating an aura of celebrity around them may contribute to an at-risk students illogical thoughts that suicide isthe only way to have a voice or to make a difference for others. However, when school personnel know that astudent is involved in bullying, they should not hesitate to ask students direct questions about thoughts of suicide.Whenever possible, discussions on bullying and suicide should center on prevention and resiliency, not statistics,and should encourage help-seeking behavior.Points to Consider WhenDeveloping Re-Entry PoliciesA school cannot require a student or their parents to provide documentation of a mental health assessment prior to re-entry following a mental health crisis. However, the following factors should be considered when determining local re-entry policy:Is there adequate availability of community-based mental health providers to ensure timely administration and documentation of student mental health status exam? (If not, the district is encouraged to have a school-employed mental health professional or trained administrator to conduct and document a suicide risk assessment to determine risk to self or others)Does the school have a relationship with local mental health agencies to help expedite the process in order to avoid long wait periods that could result in the student unnecessarily missing school?How are necessary education services and supports being provided to the student while theyre out of school? (This is particularly important for students receiving special education servicesschools should bear in mind, however, that most hospital programs only allow for a limited time devoted to school work and the vast majority of waking hours will be spent in therapy and/or learning coping techniques)Model School District Policy on Suicide Prevention | Model Language, Commentary, and Resources 21'