1. 1 Prevention Awareness Gatekeepers of Arkansas Providing Youth Suicide Prevention Awareness Talk – Ask – Listen – Keep Safe/Get Help

2. 2 IT IS UP TO US TO PROVIDE YOUTH SUICIDE PREVENTION H O P E Portions of the slides prepared by Maine Youth Suicide Prevention Program. www.mainesuicideprevention.org

3. – Language, Statistics, and Myths about suicide – Warning signs and risk factors – Basic intervention skills to use with suicidal behavior – The aftermath of suicidal behavior 3 Today We Will Cover:

4. Language Considerations 4 MUST Avoid : “successful suicide” “failed attempt” Please USE: “suicide” or “died by/of suicide” “non-fatal attempt” Should Avoid: “committed suicide” “completed suicide” “JUST a cry for help” Please USE: “died by/of suicide” “a suicide attempt” Should Avoid: “committed suicide” “completed suicide” “JUST a cry for help” Please USE: “died by/of suicide” “a suicide attempt”

5. Suicidal related communications include ideation - the direct communication of thoughts, talk, sharing of plans that may indicate a person is thinking about taking his/her own life. Suicide Attempt: A self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence of intent to die. Suicide: A self-inflicted death with evidence (implicit or explicit) of the intent to die. 5 Common Words & Phrases

6.  Suicide is the 3rd leading cause of death for Arkansas’ youth ages 15-24  Of every 5 suicides, 4 are males  Of every 15 suicides, 7 are by firearm, 4 by hanging, 3 by drowning or poison. 6 Suicide in Arkansas

7. It is estimated that there are 25 attempted suicides for each death by suicide 7 Attempted Suicides Suicide Ratio implies 900,875 suicide attempts annually in USA 11,175 Arkansans

8. 8 Attempted Suicide by sex/gender Estimated that there are: 3 female attempts for each (1) male attempt

9. Attempted Suicides Suicides Young 100:1 65 & over 4:1 Attempted Suicide & Age 10

10. 1 male and 2 females have probably attempted suicide in the past year In the typical high school classroom: 10

11.  Support family/friends  Acknowledge the impact, the fear  Avoid judging, blaming  Emphasize safety and removal of all lethal means from household  Encourage appropriate help 11 After an Attempt

12. 1)T or FPeople who talk about suicide do not actually die by suicide. 2)T or FSuicide usually happens without warning signs. 3)T or FTalking or asking someone about suicide may plant the idea and cause a suicide. 12 Facts or Myths ?

13.  Youth suicide is a problem.  We all need to learn about it.  Talking about suicide can save lives. 13 In Fact

14. SOME young children (ages 5-14) do understand the concept of death, are capable of planning a suicide and able to implement the plan.  It is a rare event, but we must not assume that children can not or do not die by suicide. They do!  Some states have documented suicides in children as young as 8 years old. 14 A Word About Young Children

15.  Warning Signs - the earliest observable signs that indicate the risk of suicide for an individual in the near- term (within minutes, hours or days.)  Risk Factors - long standing conditions, stressful events or situations that may increase the likelihood of a suicide attempt or death.  Protective Factors - personal and social resources that promote resiliency and reduce the potential of suicide. 15 Definitions

16. I deation S ubstance Abuse P urposelessness A nxiety T rapped H opelessness W ithdrawal A nger R ecklessness M ood Change 16 Warning Signs Useful Mnemonic: Is Path Warm?

17.  Depressed / Anxious  Increased alcohol/drug use  “Roller coaster” moodiness  Changes in every day behaviors  Overly pessimistic, hopeless  Neglects self, friends, usual activities Includes Behavioral, Emotional & Physical Signs: 17 Early Warning Signs of Suicide

18.  Talks of suicide, plans for how/when/where  Refuses help  Agitated, restless, picks fights  Gives away favorite things, writes a will  Shows SUDDEN improvement in mood (suicide euphoria)  Increased isolation  Uses instant messaging or phone to drop hints 18 Late Signs/Behaviors May Include:

19. 19 Listen for Verbal Clues  Direct I wish I were dead I’m going to end it all  Indirect I’m tired of it all You’ll be better off without me What’s the point of living?

20. 20

21. Depression, anxiety, or mood disorder Current or previous suicidal behavior Being a victim of sexual or emotional abuse Conduct problems Access to lethal means 21 Risk Factors for Adolescent Suicide

22.  Supports - Supportive parents, friends, teachers & other caring adults  Skills to think, communicate, solve problems, manage anger  Purpose & value in life-hope for future  Personal characteristics - good health, positive outlook, healthy choices  Safe Environment – restricted access to lethal means 22 Protective Factors

23.  There is a lot of cross-over between Risk Factors and Warning Signs!  There is no particular set of risk factors that accurately predicts imminent danger.  There is no “typical” suicidal person - there are ALWAYS varying degrees of risk factors. 23 Very Important to Remember…

24.  Crisis point has been reached  Distress/torment/anxiety seems unbearable  Solutions to problems seem unavailable  Rational Thinking is affected  Ambivalence exists between wanting to live and wanting to end the psychological pain  Need to communicate pain is intense! 24 From a Suicidal Person’s Point of View

25. 25 Worthless Lonely Sad Hopeless Helpless ACTIONS THOUGHTS “All of my problems will end soon” “No one can do anything to help me now” “I wish I were dead” “Everyone will be better off without me” “I won’t be needing these things anymore” “I can’t do anything right” “I can’t think straight” Giving away possessions Withdrawal (family, friends, school, work) Loss of interest in hobbies Abuse/use of alcohol, substances Reckless behavior Extreme mood swings PHYSICAL Lack of interest in appearance Changes in appetite, weight Change in sleep patterns Desperate Angry Guilty FEELINGS Invitations to Help

26.  Inability/lack of knowledge  Worry about doing/saying the “right” thing  Feelings of inadequacy  Belief in myths of suicide 26 Intervention--Why People Hesitate

27.  Ignoring or dismissing the issue  Acting shocked or embarrassed  Challenging, debating or bargaining  Giving harmful advice 27 What is NOT Helpful

28. 1)Show You Care—Listen carefully—Be genuine “I’m concerned about you... about how you feel.” 2)Ask the Question—Be direct, caring and non- confrontational “Are you thinking about suicide?” 3)Get Help—Do not leave him/her alone “You’re not alone. Let me help you.” 28 What IS Helpful

29. Use handout: “What Is Helpful 3-Step Intervention” 1.Think up & write 1 or 2 phrases or ways that YOU would use to “show you care.” 2.Write two other ways you might “ask the question” about suicide. 3.List two ways you would try to convince someone to “get help” and name two resources. 29 Practice Helpful Steps!

30. 30 Resources for Help – Phone numbers  Arkansas Crisis Hotline 1-888-CRISIS2 (1-888-274-7472)  National Suicide Crisis Hotline 1-800-273-TALK (8255) Or 1-800-SUICIDE (1-800-784-2433) En Español 1-888-628-9454 TTY capability 1-800-799-4TTY (4889)  Arkansas Crisis Hotline 1-888-CRISIS2 (1-888-274-7472)  National Suicide Crisis Hotline 1-800-273-TALK (8255) Or 1-800-SUICIDE (1-800-784-2433) En Español 1-888-628-9454 TTY capability 1-800-799-4TTY (4889)

31.  National Suicide Prevention Lifeline  http://www.suicidepreventionlifeline.org/ http://www.suicidepreventionlifeline.org/  MYSPP Web Site: www.mainesuicideprevention.orgwww.mainesuicideprevention.org  Online Crisis Chat:  www.crisischat.org or www.arcrisis.org www.crisischat.orgwww.arcrisis.org 31 Resources for Help - Websites

32.  School Administrators  School Counselors  Teachers & School Staff  School Nurses & Health Services  Social Workers  School Crisis Team  School Resource Officer  Any Trusted Adult 32 School Resources for Help

33.  When Any Concern Is Raised Contact:  Principal & School Counselor  School Crisis Team  Parent or Guardian  Have a Suicide (Risk) Assessment Administered 33 Our school protocol is…

34. It is estimated that there are 6 survivors  Ratio implies 199,800 new survivors of suicide annually 34 Number of Suicide Survivors A “suicide survivor” is someone who has lost a loved one to death by suicide 2,412 Arkansans in 2008 for each death by suicide

35.  Struggle to make meaning of the loss  Suffer from overwhelmingly complicated feelings  May take a long time to grieve  Need understanding and support  Youth survivors have special issues 35 Survivors of Suicide

36.  Acknowledge the loss  Share a special memory/story  Use the name of the deceased  Share your presence  Acknowledge the good things  Stay in touch  Call local hospice center for grief support groups 36 How you can help after a suicide

37.  Age: Certain ages more than others.  Gender: One gender more than the other.  Stress: Troubling experiences that challenge the person’s ability to cope.  Warning Signs: Behaviors that can be observed (Aggression, Sadness, Drug or Alcohol Abuse) 37 Factors Used in Estimating the Risk of Suicide

38.  Current Suicide Plan: Whether or not there is a plan and any details of that plan  Prior Suicidal Behavior: Personal history of suicide or suicide attempt(s): including “modeling” by family, friends or others  Resources/Protective Factors: Physical and emotional resources which the person feels are helping, caring or supportive 38 Additional Factors Used in Estimating the Risk of Suicide

39. Your Rank Rank ___ Age ___ Gender ___ Stress ___ Warning Signs ___ Current Suicidal Plan ___ Prior Suicidal Behavior ___ Resources/Protective Factors 5 4 6 3 1 2 7 39 Estimate the Risk of Suicide

40.  Acknowledge the intensity of your feelings  Seek support, de-brief  Share your feelings  Avoid over – involvement  Know that you are not responsible for another person’s choice to end their life 40 Responders – Take Care of Yourself!

41. The story on video we are about to see is true. It concerns a suicide intervention that occurred only days after the end of a suicide prevention learning unit done at a Maine middle school health class. It is told by the real student and guidance counselor involved. No scripts were used, no rehearsals held and no special lighting or sound systems. A high school student did the actual digital filming. 41 “A LIFE SAVED”

42. Business Office: (479) 756-1995 Fax: (479) 756-2338 Email: www.arcrisis.org AR Crisis Hotline: 1-888-274-7472 Arkansas Crisis Center 42

43. Any Questions? 43 Before You Leave… Thank You.. For learning about suicide prevention ADE Support: betty.welch@arkansas.gov roger.palmer@arkansas.gov