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A Trauma-Informed Understanding of Suicidality Elizabeth Hudson, LCSW Consultant to WI Dept. of Health Services Employed by University of Wisconsin - Madison.

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Presentation on theme: "A Trauma-Informed Understanding of Suicidality Elizabeth Hudson, LCSW Consultant to WI Dept. of Health Services Employed by University of Wisconsin - Madison."— Presentation transcript:

1 A Trauma-Informed Understanding of Suicidality Elizabeth Hudson, LCSW Consultant to WI Dept. of Health Services Employed by University of Wisconsin - Madison

2 Psychological Trauma - What is it? E xtreme stress (e.g., threat to life, bodily integrity or sanity) that overwhelms a person’s ability to cope. The individual’s subjective experience determines whether or not an event is traumatic. Traumatic events result in a feelings of vulnerability, helplessness and fear. Traumatic events often interfere with relationships and fundamental beliefs about oneself, others and one’s place in the world. Posttraumatic Stress Disorder = re-experiencing, avoidance/numbing & hyperarousal )

3 Psychological Trauma - Examples Violence in the home, personal relationships, workplace, school, systems/institutions, or community Maltreatment or abuse: emotional, verbal, physical, sexual, or spiritual Exploitation: sexual, financial or psychological Abrupt change in health, employment, living situation over which people have no control Neglect and deprivation War or armed conflict Natural or human-caused disaster

4 Trauma-related Statistics 56% of the general population reported at least one traumatic event (Kessler,1995) 90% of mental health clients have been exposed to a traumatic event and most have multiple exposures (Muesar, 1998) 83% of females and 32% of males with developmental disabilities have experienced sexual assault. (Hard, 1986) Of those who were assaulted, 50% had been assaulted 10 or more times (Sobsey and Doe, 1991) 97% of homeless women with mental illness experienced severe physical and/or sexual abuse (Goodman, Dutton et al., 1997)

5 Trauma has been associated with suicide- related thoughts or behaviors in populations such as: –Vietnam veterans (Fontana and Rosenheck, 1995),Fontana and Rosenheck, 1995 –American Indians (Robin et al., 1997),Robin et al., 1997 –psychiatric inpatients (Sfoggia et al., 2008),Sfoggia et al., 2008 –people with substance disorders (Roy et al., 2007),Roy et al., 2007 –medical students (Jeon et al., 2009),Jeon et al., 2009 –college students (Bryant and Range, 1997),Bryant and Range, 1997 –adolescents (Lipschitz et al., 1999),Lipschitz et al., 1999 –military men and women (Hoge et al., 2004).Hoge et al., 2004

6 Adverse Childhood Experience (ACE) Study

7 ‘ACE’ Abuse Psychological (by parents) Physical (by parents) Sexual (anyone) Physical neglect Emotional neglect Household with: Substance abuse Mental illness Separation/divorce Domestic violence Imprisoned household member

8 Childhood Experiences Underlie Suicide 1 2 0 3 4+

9 Complex Trauma / Complex PTSD / Developmental Trauma Disorder Result of traumatic experiences that are interpersonal, intentional, prolonged and repeated

10 Symptoms of Complex Trauma Re-experiencing Avoidance/ Numbing Arousal PLUS Emotional difficulties: managing feelings; chronic anxiety; empathizing; low frustration tolerance; expressing needs, thoughts, concerns using words Cognitive difficulties: cognitive biases; understanding what is being said; doing things in logical sequence; seeing ‘gray’; working with time; multiple ideas simultaneously; maintaining focus Social difficulties: attending to or accurately assessing social cues; connecting with others; seeking attention in appropriate ways; appreciating how behavior impacts others Handling transition and change: impulsive; adapting to change; handling unpredictability, ambiguity, uncertainty & novelty Interference with developmental momentum: social withdrawal; decreased range of affect; regression in development; decrease in play


12 Impact on Worldview Typical Development vs. Developmental Trauma Nurturing & stable attachments with adults Belief in a predictable & benevolent world/ generally good things will happen to me Feeling of positive self- worth /others will see my strengths Optimism about the future Feeling that I can have a positive impact on the world Basic mistrust of adults/inability to depend on others Belief that the world is an unsafe place/bad things will happen & they are usually my fault Assumption that others will not like me Fear & pessimism about future Feelings of hopelessness & lack of control

13 Mediating or Exacerbating Factors Person Age / developmental stage Past experiences and coping skills Environment Presence of sensitive & supportive ‘other’ Safe community Access to supportive resources Culture and cultural beliefs Event Severity & chronicity Interpersonal vs. act of nature Intentional vs. accidental

14 Suicidality and Surviving Trauma: Shared Elements People often… –aren’t asked –don’t tell –feel they have secret and experience shame –experience failure and sense of unworthiness –feel isolated and alone –feel helpless and hopeless –feel detached –have impaired judgment and self-regulation (Hodas, 2008)

15 Providers Respond … Hospitalization Psychotropic medication Outpatient treatment

16 Trauma-Informed Care What it is: a philosophical shift What it is not: an intervention to address PTSD ----------------------- Moving from, ‘What’s wrong with you’ to ‘What’s happened to you?’

17 Shneidman’s Two Questions Where do you hurt? How can I help? (McCord, Marian University, September, 2011)

18 Trauma-Informed Care – What is it? Incorporate knowledge about trauma – prevalence, impact, and recovery – in all aspects of service delivery Place priority on: 1. meaningful consumer engagement 2. physical and emotional safety 3. choice 4. collaboration / sharing power 5. empowerment and skill building (1-5, Fallot & Harris) 6. healing relationships Increase caregiver capacity

19 Guiding Values of Trauma-Informed Care Healing Happens in Relationship

20 TIC within Suicide Prevention: Beliefs People often feel out of control, but don’t talk about it Core considerations: avoid power struggles and the use of shame & humiliation People need… –trusting relationships –information for self-awareness and goals –to develop more effective coping skills –support in regaining hope (Hodas, 2008)

21 TIC within Suicide Prevention: Practices Address any continuing trauma or danger Actively engage and build relationship Be welcoming and non-judgmental Build on strengths Gather trauma and treatment history Anticipate needs and intervene early Ensure that treatment is available and appropriate (Hodas, 2008)

22 TIC within Suicide Prevention: Practices Help people… –understand trauma history, symptoms & behaviors, impact on life and how to change –learn to recognize & control triggers –Approach ‘failures’ as opportunities to learn Promote… –self-expression –acquisition of social skills –coping & wellness (Hodas, 2008)

23 Tool: WRAP Plan WRAP Plan should address: –Preferred ways of calming –Triggers –Signs and symptoms of triggers –What people want helpers to do and not to do –What people want to be encouraged to do –Identification of others who can provide support (Hodas, 2008)

24 Trauma Resources National Center for Trauma-Informed Care National Center for Posttraumatic Stress Disorder National Child Traumatic Stress Network International Society for Traumatic Stress Studies http://www.istss.orgI http://www.istss.orgI International Society for the Study of Trauma and Dissociation http://www.isstd.org The Anna Institute.

25 Sample of Models, Guides and Resources The Anna Institute. Developing Trauma-Informed Organizations, Inst. for Health and Recovery. Risking Connection, Sidran Institute. The Sanctuary Model, CommunityWorks. Using Trauma Theory to Design Service Systems, Fallot & Harris, Community Connections.

26 School and Teaching Resources Helping Traumatized Children Learn Massachusetts Advocates for Children 2005 The Heart of Learning & Teaching Compassion, Resiliency & Academic Success Wolpow, Ray; Johnson, Mona M.; Hertel, Ron; Kincaid, Susan O. 2009 Creating Sanctuary in Schools 1995 Bloom, Sandra Child Trauma Toolkit for Educators National Child Traumatic Stress Network

27 Credits Multiple slides were taken from the work of… Gordan Hodas, Pennsylvania 2 nd Annual Suicide Prevention Conference, Trauma- Informed Care & Youth Suicide Prevention (2008) Janet McCord, Marian University of Fond du Lac, Shneidman in a Nutshell: Psychache and Suicide (2011)

28 Contact Information Elizabeth Hudson, LCSW Trauma-Informed Care Consultant WI Dept. of Human Services Division of Mental Health and Substance Abuse Services 608-266-2771 Employed by University of Wisconsin - School of Medicine and Public Health

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