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:
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
STATS WHY? SPAN IDAHO ? ? ? ? ? SAVE A LIFE SURVIVOR SUPPORT CLINICAL PREVENTION FACILITIES
A 501(c)(3) non-profit Vision : Idahoans choose to live A Resource
2 nd leading cause of death among Idaho’s youth. 29%
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
Idaho has lost 83 school-aged children to suicide in the last 5 years. ( ) 16 of those children were age 14 or younger
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.
The Suicidal Mind
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
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.”
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
Suicide: Fact vs. Fiction
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.
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!
SUICIDE IS COMPLEX Substance Abuse Lack of Support Hopelessness Previous Attempt Abuse Mental Illness Family History
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
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?
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
What to Look For
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
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
“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
“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
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
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.
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
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
What to Do
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.
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
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.
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
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
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!
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
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.”
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
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
N=1,671 CT, ME, UT, WI, Allegheny County, San Francisco County 2001 Data Impulsivity
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
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
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
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
Simply be there Be a friend, family, neighbor, church community After 2 weeks – Reach out Anniversaries
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
Written policies for prevention, intervention, responding to attempts and postvention All staff trained on when and how to implement these policies/plans
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
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
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
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.
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
Suicide Prevention Resource Center SPAN Idaho National Center on Institutions and Alternatives