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Suicide and What Can Make a Difference Kim Kane, MPA Program Director, Idaho Lives Project Former Executive Director, SPAN Idaho Member, Idaho Governor’s.

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Presentation on theme: "Suicide and What Can Make a Difference Kim Kane, MPA Program Director, Idaho Lives Project Former Executive Director, SPAN Idaho Member, Idaho Governor’s."— Presentation transcript:

1 Suicide and What Can Make a Difference Kim Kane, MPA Program Director, Idaho Lives Project Former Executive Director, SPAN Idaho Member, Idaho Governor’s Council on Suicide Prevention Certified QPR Suicide Prevention Trainer

2 STATS WHY? SPAN IDAHO ? ? ? ? ? SAVE A LIFE SURVIVOR SUPPORT CLINICAL PREVENTION FACILITIES

3  A 501(c)(3) non-profit  Vision : Idahoans choose to live  A Resource  

4 BOARD OF DIRECTORS 13 Volunteers STAFF Executive Director Resource Specialist REGIONAL CHAPTERS 8 Chapters Volunteer chairperson(s) Volunteer participants 8 Driggs (new)

5 Stats

6 US 2011 ID 2011 ID 2012 ID 2013 Total Deaths 39, Deaths/week Suicide Rate

7 Sun.Mon.Tues.Wed.Thurs.Fri.Sat. 1X1X 23X3X 4X4X 5X5X 6X6X 7X7X 8X8X 9X9X 10 X 1112 X 13 X 14 X 15 X 1617 X 18 X 19 X 20 X 21 X 22 X 23 X 2425 X X 28 X 29 X 30 X 31 X

8 WyomingIdaho U.S. D.C

9 1. Wyoming 1. Montana 3. New Mexico 4. Alaska 5. Vermont 6. Nevada 7. Oklahoma 8. Arizona 9. Colorado 9. Utah 11. Idaho  We are not unlike our neighbors  Top Eleven States, 2011

10 1. Wyoming 2. Alaska 3. Montana 4. Nevada 5. New Mexico 6. Idaho 7. Oregon 8. Colorado 9. South Dakota 10. Utah 11. Arizona  We are not unlike our neighbors  Top Eleven States:

11  Lack of Access  Easy Access  Stigma/Rugged individualist culture Boot straps

12  2 nd leading cause of death among Idaho’s youth. 29%

13  Idaho high school students, 2013 YRBS shows 1 in 13 have attempted suicide 1 in 8 actually have a suicide plan 1 in 7 have considered suicide

14  Idaho has lost 83 school-aged children to suicide in the last 5 years. ( )  16 of those children were age 14 or younger

15 Suicide is the leading cause of death in American jails. Suicide rates in prison are higher than the general population, but higher still are rate in smaller facilities Suicide rates in local jails are 4 - 9x than the national rate.

16 The Suicidal Mind

17 Those who enact murder-suicide, including school shooters are first suicidal. Suicide is primary; murder is secondary. “To understand the primary source code of violence – the suicidal mind – we must first understand that persistent suicidal thoughts and feelings are markers of unremitting, unendurable psychological pain and suffering.” ~ Paul Quinnett, PhD

18  Distinguished Research Professor and The Bright-Burton Professor in the Department of Psychology at Florida State University  Author of over 400 peer-reviewed publications  Editor-in-Chief of the journal Suicide & Life-Threatening Behavior  Author of “Why People Die by Suicide,” “Myths About Suicide” and “Lonely at the Top.”

19 Perceived Burdensomeness Thwarted Belongingness Those Who Are Capable of Suicide Fearlessness about Pain, Injury & Death Acquired Ability for Self-Harm Serious Attempt or Death by Suicide Those Who Desire Suicide Derived from Sketch of a Theory Power Point presentation, 2013 Thomas Joiner, PhD DistalFactorsDistalFactors Why People Die by Suicide

20 Suicide: Fact vs. Fiction

21 1. Asking someone about suicide might “plant the seed” or increase risk. 2. More females attempt suicide than males. 3. Suicides increase over the winter holidays. 4. Very young children complete suicide. 5. Most suicidal people are ambivalent about it. 6. Suicide is often done on whim, especially among youth. 7. Restricting access to lethal means is a critical prevention method.

22  People routinely survive deep depression and suicidal thoughts and behaviors.  The basic instinct to survive is ever-present.  Suicidal people survive because someone identifies what’s happening and gets help.  90% of those who complete suicide had a mental health or substance about disorder. THESE DISORDERS ARE TREATABLE!

23  SUICIDE IS COMPLEX Substance Abuse Lack of Support Hopelessness Previous Attempt Abuse Mental Illness Family History

24  Suicide is multi-facetted  There is never just one thing that leads to suicide  There can, however, be a triggering event: Arrest itself Fear of transfer to more secure facility or undesirable placement Failure in the program Suicide of a peer/contagion Threat of/failure to visit Death in the family Loss of relationship Ridicule from peers

25  90% of those who die by suicide had a mental health and/or substance use disorder.  55%-75% of those in jail or prison have a mental health disorder, including depression.  Three quarters of those have a co-occurring substance use disorder. What does this tell us about the potential for prevention?

26 Unhelpful Helpful Suicide is inevitable Suicide is preventable Suicide is selfish Suicidal youth irrationally believe they are a burden S/He only wants attention Threats and attempts are two of the most significant precipitating factors for suicide Labeling suicidal thoughts Such labels increase stigma or behavior as irrational or and can cause youth to shut “crazy” down/not seek out or accept help

27 What to Look For

28  The more signs, the greater the risk.  Warning signs are especially important if the person has attempted suicide in the past.  One sign alone may not indicate suicidality but all signs are reason for concern and several signs may indicate suicidality, and any one of three signs alone is cause for immediate action RISKRISK

29  Previous suicide attempts  Talking about, making a plan or threatening to complete suicide  Isolation, withdrawal from friends, family or society  Agitation, especially when combined with sleeplessness  Nightmares

30  “I’ve decided to kill myself.”  “I wish I were dead.”  “I’m going to commit suicide.”  “I’m going to end it all.”  “If _______ doesn’t happen, I’ll kill myself.” QPR Institute

31  “I’m tired of life; I just can’t go on.”  “My family would be better off without me”  “Who cares if I’m dead anyway.”  “I just want out.”  “Pretty soon you won’t have to worry about me.” QPR Institute

32  Changed eating habits or sleeping patterns  Giving away prized possessions, making final arrangements, putting affairs in order  Themes of death or depression in conversation, writing, reading or art  Recent loss of a friend or family member through death, suicide or divorce  Sudden dramatic decline or improvement in the program

33  Feeling hopeless or trapped  Use or increased use of drugs and/or alcohol  Chronic headaches and stomach aches, fatigue  Major mood swings or abrupt personality changes  Neglect of personal appearance  Taking unnecessary risks or acting reckless  No longer interested in favorite activities or hobbies.

34  Room Confinement  Withdrawal from Alcohol or Drugs  Court or other Legal Hearing  Significant Date to the Offender  Receipt of Bad News  Impending Release/Transfer  Family Threat of/Failure to Visit  Failure/Lack of Progress in the Program  Ridicule from Peers  Severe Guilt or Shame about Offense  Sexual/Physical Assault

35  Talking about wanting to die or to kill oneself  Looking for a way to kill oneself  Talking about feeling hopeless or having no reason to live

36 What to Do

37  Any suspicion that the person may be suicidal must be acted upon.  Any report of such suspicions by the person’s family or other inmates (if incarcerated) should also be taken seriously.

38  Yes, some may use the threat of suicide or a feigned suicide attempt to manipulate the system or get attention.  Attention-getting tells us something.  Challenging to tell the difference  Attempt habituation can lead to underestimation of lethality.  TAKE ALL THREATS SERIOUSLY

39  Connect with the person  Avoid discussing personal info that may be embarrassing in front of others  Reduce stress of the unknown  Monitor emotions before and after visitation or calls  Assist the person in managing conflict  Encourage discussion and role play re: court or PO visit, etc.

40  Can be challenging – be persistent  Talk in semi-private location if possible  Avoid trying to identify with the person  Avoid trying to argue him/her out of it  Understand, listen and refer  Try to understand how the person may see him/herself: Rigid thinking, overgeneralizing, catastrophizing, attachment, trauma

41  Listening is Powerful! Explore suicidality – level of intent Listen non-judgmentally Use reflective listening Reasons for dying Refrain from offering advice/solutions or interrupting with your experience Reasons for living Offer hope, support, willingness to help/get help

42  Get a commitment to accept help and make arrangements and contact family/friends  Ensure person is not left alone  Notify family  If person is deemed to be at high risk, also contact mental health agency where the person can go for further help.  TALK (8255)  Call police if person is in possession of a weapon  Follow up with person/family and mental health agency  Debrief staff involved – self care  Document everything!

43

44 Clinical Prevention

45  Not about curing mental illness  Reduce stigma associated with mental health problems  Reduce stigma associated with help-seeking Being in treatment and using crisis services  Remove barriers to getting help  Building Hope Symptom reduction Identity change  Resolving hopelessness Relationships that last Finding a life worth living From M. David Rudd, PhD

46  Suicidality is fluid Tad Friend. Jumpers. The New Yorker (2003) On the bridge, Baldwin counted to ten and stayed frozen. He counted to ten again, then vaulted over. “I still see my hands coming off the railing,” he said. As he crossed the chord in flight, Baldwin recalls, “I instantly realized that everything in my life that I’d thought was unfixable was totally fixable—except for having just jumped.”

47 Elements of Intent Gives Clues to Suicide Risk  Willingness to act (motivation to die) People talk about reasons for dying  Preparation to act (preparation and rehearsal behaviors) People prepare for their death  Will, letters, finances, research  Capability to act Builds over time with exposure Ordinarily people engage in the behavior for some time prior to death  High Risk Behavior  Self-mutilation  Suicide Attempts  Barriers to act (reasons for living) People will discuss their ambivalence about death Relationships critical From M. David Rudd

48  The role of shame and guilt Influence on the assessment dynamic  Recognize the fluid nature of intent  Identify and reinforce individual ambivalence Reasons for dying are readily accessible to those in crisis Reasons for living are often unrecognized and inaccessible From M. David Rudd, PhD

49 N=1,671 CT, ME, UT, WI, Allegheny County, San Francisco County 2001 Data Impulsivity

50 Hospital Discharge – THE warning sign Capability Loss of connectedness Burdensomeness Shame/Embarrassment Non-Compliance with treatment ~37% of suicides are by those in treatment Represents persistence of hopelessness and intent Issue of personal responsibility for care Potential implicit messages Treatment doesn’t work Treatment is hopeless From M. David Rudd, PhD

51 1. Easy to understand treatment model Identify early skill development/deficiencies related to current functioning Target  Thoughts (core beliefs) – motivation for dying  Feelings (physiological/emotional)  Behavior (increasing adaptive) 2. A Focus on Treatment Compliance Specific interventions to target poor adherence Clear directions about what to do in non-adherence emerges From M. David Rudd, PhD

52 3. Focus on Skills-Building Identify skill deficits with opportunity for skills building practice  Emotion regulation  Interpersonal Clear understanding of “what is wrong” and “what to do about it” Separate from identity 4. Taking personal responsibility Emphasis on self-reliance and self-management (commitment to treatment statement, safety plan - PRACTICE) Patients assume high level of responsibility for their care, including crisis management 5. Easy access to treatment and crisis services From M. David Rudd, PhD

53  Items that generate productive, hopeful thoughts and feelings  Always review items individually  Practice use (review; describe; ask what are you thinking & feeling? Are you more hopeful?) From M. David Rudd, PhD

54 Survivor Support

55  Simply be there  Be a friend, family, neighbor, church community  After 2 weeks – Reach out  Anniversaries

56  Suicide Survivor Packets: contact SPAN  Support groups Boise Area Facilitators: Kirby and Susan Orme Where: First United Methodist Church Cathedral of the Rockies 11th and Hays Streets, Boise Olivet Room, enter through glass doors on 11th Street When: Second Friday of each month from 7:00 to 9:00 p.m. Meridian Area Facilitator: Cynthia Mauzerall Where: Holy Apostles Church, 6300 N Meridian Rd., Meridian When: Fourth Monday of each month from 7:00 to 8:30 p.m. click Survivor Support  Books No Time to Say Goodbye, Carla Fine Night Falls Fast, Kay Redfield Jameson

57 Facilities

58  Written policies for prevention, intervention, responding to attempts and postvention  All staff trained on when and how to implement these policies/plans

59  Protocols must include: Assessing suicide risk and imminent suicide risk  Beyond intake because suicidality is fluid Effective communication about suicide risk  Risk status and history can get lost in the shuffle  Staff must be vigilant  Information that must follow the inmate: suicide threat made, behavior indicating depression, history of psychiatric care and meds, status of protective custody

60  Should be part of admission process  Should NOT be a one-time occurrence  Mental health staff: formal assessment  Non-mental health staff may need to do an informal assessment Ask the question --- more than once if necessary How to ask, how not to ask If they keep denying, is everything okay? AGAIN

61  Use of isolation cells Increases risk of suicide If an inmate at risk requires isolation ensure cell is suicide- resistant  Consider all anchors and ligatures  Training for staff Recognizing and responding to suicide risk CRP and first aid Rescue tools  Availability of first aid safety equipment Latex gloves Resuscitation breathing masks Defibrillators Tools to open jammed cell doors Cutting tools for ligatures

62  Anchors: Any tie-off point  Ligature: Anything used to hang oneself; any material which can be tied around the neck and withstand body weight or strangle (clothing hooks, shower knobs, cell doors, sinks, toilets, ventilation grates, windows, smoke detectors)  WHY?  Majority of inmate death are by hanging  Result in death in 5-6 min.; brain death in 4 min.

63  Reporting: Notify all appropriate staff, family, appropriate outside authorities All staff in contact with the deceased prior to incident should submit a statement as to their full knowledge of the youth and incident  Mortality Review  Minimize Contagion Share facts to prevent rumors Do not simplify, glamorize or romanticize the person or his/her death Emphasize that suicide is rare and is not a common response to problems with which other young adults may identify Monitor young adults and most vulnerable and refer those struggling with the death  SPAN Idaho Postvention Guidelines  Liability - “Deliberate indifference” & Not intervening does not equal protection from liability  Self Care

64 Suicide Prevention Resource Center SPAN Idaho National Center on Institutions and Alternatives

65 Kim Kane Program Director Idaho Lives Project


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