1. NOTICE ME! Understanding Depression and Suicide Summit County Suicide Prevention Coalition Summit County ADM Board Andrea Denton September, 2011

2. August 15Gatekeeper Training2 WHY ARE WE HERE?  We care about what is happening to our community….our families and our friends.  We don’t want any more tragedies.  We want to make a difference.

3. August 15Gatekeeper Training3 AND BECAUSE… We are some of the people that others look up to for answers when life is confusing. We are trying to figure out why someone would find life so painful that death becomes the way to resolve the situation.

4. August 15Gatekeeper Training4 WHAT WE HOPE TO LEARN  The impact of suicide within the community.  The connection between depression and suicide  The myths and misconceptions about suicide.  The risk factors and signs of suicidal behavior.  Finding help for those at risk.

5. August 15Gatekeeper Training5 A BASIC UNDERSTANDING… Many people are uncomfortable discussing suicide. We fear the topic. We don’t understand it BUT, KNOWLEDGE IS POWER! The more we know…the more we can help.

6. August 15Gatekeeper Training6 OUR LANGUAGE MATTERS We can take the judgment out of our language by using phrases like: “died by suicide” “death by suicide” “completed suicide” Instead of saying “committed suicide”

7. August 15Gatekeeper Training7  It ranks 11 th as a cause of death in America.  As many as 25% of adolescents and 15% of adults consider suicide at some point in their lives.  More people die using firearms than by any other method. A PERSPECTIVE ON SUICIDE

8. August 15Gatekeeper Training8  A suicide attempt is a desperate cry for help to end hopelessness and excruciating, unending, and overwhelming pain.  Suicidal people don’t necessarily want to die. They want their pain to end.

9. August 15Gatekeeper Training9  94.8 people die by suicide every day in the U.S.  34,598 people died of suicide in 2007 in the U.S.  65 people died of suicide in Summit County in 2010.  Nationally, one person dies of suicide every 15.2 minutes. IS SUICIDE REALLY AN ISSUE?

10. August 15Gatekeeper Training10  These statistics are the best we have, but there may be as many as 2 to 3 times more people who complete suicide than are reported.  For every 1 homicide, 2 people complete suicide. THE SIZE OF THE PROBLEM

11. August 15Gatekeeper Training11 U.S. SUICIDE STATISTICS - 2007  Rates per 100,000 National Average11.5 Caucasian Males20.5 African American Males 8.4 Caucasian Females 5.4 African American Females 1.7 Elderly (65+ years)14.3 Children (5-14).5 Youth: (15-24) 9.7

12. August 15Gatekeeper Training12 GENDER ISSUES Females:  Make attempts 4 times as often as men.  Their risk rises until midlife, then decreases. Males:  Complete suicide 4 times as often as women.  Their risk is always higher than women and continues to rise until end of life.

13. August 15Gatekeeper Training13 WHY THE DIFFERENCE? Could it be that… …Females are more likely to seek help? …Females are more likely to talk about feelings? …Males suffer from depression silently?

14. DEPRESSION AND SUICIDE Their Relationship………..

15. August 15Gatekeeper Training15 THE STORY  It is estimated that as many as 90% of suicidal people suffer with a depressive illness, either diagnosed or undiagnosed.  Upon reaching puberty, statistics show girls are affected by clinical depression twice as often as boys. However, some feel that perhaps boys are just not diagnosed as quickly or easily.

16. August 15Gatekeeper Training16  Just as a person with diabetes has low insulin production, a person with depression suffers from the mind’s inability to function correctly.  Depression and stress can cause changes in the physical structure of the brain and damage to brain cells.  The symptoms of depression can be mild to severe for any individual person. FAULTY WIRING

17. August 15Gatekeeper Training17  A moral failing  A spiritual weakness  “The coward’s way out”  A selfish act But, after years of brain research, we now know that the symptoms of depression have a biological basis. SUICIDE HAS BEEN VIEWED AS…

18. August 15Gatekeeper Training18  Medications help to repair the damage to nerve connections. It may take 4 to 6 weeks for them to be effective.  Counseling helps to teach new coping and problem- solving skills and different ways to interpret stressful events. Counseling can change negative ways of thinking that can lead to suicidal thoughts. TREATMENT FOR DEPRESSION

19. August 15Gatekeeper Training19 For most people, the best treatment is medication and counseling combined.  Some people can also benefit from group therapy, support groups and other social supports.  Treatment is designed specifically for the individual.  Watch the person carefully for at least six months.

20. August 15Gatekeeper Training20 WITHOUT TREATMENT?  Risk of increased alcohol and drug use.  Significant relationship issues.  Lost school days or work days and inability to plan for future.  Higher risk for suicidal thoughts, attempts and death.

21. August 15Gatekeeper Training21 WHAT DO WE WATCH FOR? Depressed or Irritable Appearance  Frequent crying  Unhappy presentation  Angry outbursts  Wears dark or monotone clothing  Writes, reads or listens to music with violent or depressive themes  Truancy becomes a problem

22. August 15Gatekeeper Training22  Withdrawal from favorite activities or people  Changes in friends  Poor hygiene  Moves more slowly or can’t sit still  Rapid changes in weight  Changes in sleeping habits  No energy to manage duties  Physical complaints  Inability to concentrate AND……

23. August 15Gatekeeper Training23 MORE PROBLEM BEHAVIORS  Acting out a will  Talking about death and dying  Making verbal threats: “I’m no good to anyone”; “I can’t go on without____”; I wish I were dead.”  Looking for methods, weapons…creating a plan.

24. August 15Gatekeeper Training24 “ What is wrong with______? He or she seems so different from the way they used to be. If this happens, look at the patterns of behavior and see what your gut reaction tells you. LISTEN!

25. August 15Gatekeeper Training25 BE ESPECIALLY WORRIED IF…  The person made a prior suicide attempt.  They lost someone to suicide.  They are using or abusing substances.  They have had a recent loss (relationship, family death, job, pet, freedom).  They are in trouble anywhere.

26. August 15Gatekeeper Training26 OR… They are struggling with sexual orientation issues. Four times higher risk for suicide than their heterosexual peers More frequent and more lethal suicide attempts Significantly higher rates of depression, substance abuse and suicidal ideation

27. August 15Gatekeeper Training27 OR……  They have an illness that makes them feel different, especially if it is newly diagnosed.  They express hopelessness about life.  They are in emotional pain and can’t see that things will improve.

28. RISK FACTORS AND PROTECTIVE FACTORS

29. August 15Gatekeeper Training29 RISK FACTORS GENETICS Depression can run in families. A family history of suicide increases risk by 6 times. ENVIRONMENT People are affected by psychological trauma, abuse, chronic illness, medications or the problem-solving techniques of others. SITUATIONAL FACTORS Violence, illness, sudden loss or any severe shock to the system can bring on suicidal feelings.

30. August 15Gatekeeper Training30 MORE SITUATIONAL FACTORS  Substance use  Access to firearms or other lethal means  Significant loss (like death, separation, divorce, break up, etc.)  Social isolation, feeling alone or picked on.  Feeling trapped or like a burden  History of violence, aggression or impulsiveness

31. August 15Gatekeeper Training31  Restricted access to lethal means.  Support of family and friends.  Having coping skills  Community support like belonging to church, groups or organizations.  Ongoing medical and/or mental health care relationships. PROTECTIVE FACTORS

32. August 15Gatekeeper Training32  Beliefs that discourage suicide and support self- preservation  Future plans; sees self in the future  Sense of purpose  Is ambivalent (struggling with whether to live or die)  Is able to connect with people and seek help AND…

33. MYTHS AND FACTS

34. August 15Gatekeeper Training34 MYTHS AND FACTS  Sorting out the truth……..  Knowing what to believe…..  Sharing your expertise……

35. August 15Gatekeeper Training35 FACT vs. MYTH… MYTH: A person who threatens suicide won’t really follow through. FACT: Almost 80% of people who complete suicide have talked about it with someone before they die by suicide. Students are particularly good at sharing with friends so friends need to be told to not keep someone’s suicidal feelings a secret.

36. August 15Gatekeeper Training36 FACT vs. MYTH… MYTH: No one I know would do that. FACT: Suicide is an equal opportunity killer. Rich, poor, successful, unsuccessful, beautiful, ugly, young, old, popular, and unpopular people all die of suicide.

37. August 15Gatekeeper Training37 FACT vs. MYTH… MYTH: Once a person decides to die nothing can stop them. They really want to die. FACT: Most people actually want to be stopped. Most individuals want to end the pain, not their lives. They often feel there is no hope.

38. August 15Gatekeeper Training38 FACT vs. MYTH… MYTH: Asking someone if they are suicidal might cause a person to think about suicide or to attempt suicide. FACT: It is helpful to talk openly with someone who is having suicidal thoughts. Many people are relieved at the chance to talk about the thoughts. You will not put the idea of suicide into someone’s head.

39. August 15Gatekeeper Training39 FACT vs. MYTH… MYTH: They are just trying to get attention. FACT: They are trying to get help. We must recognize that need and respond to it.

40. AMBIVALENCE August 15Gatekeeper Training40

41. I’M NOT A PSYCHIATRIST… …WHAT CAN I DO?

42. August 15Gatekeeper Training42 WHAT CAN I DO?  Think of depression as an illness, like heart disease.  Try to understand that the person is feeling serious pain.  Think of suicidal thoughts as a crisis in that illness, like a heart attack.

43. August 15Gatekeeper Training43 WHAT IF…  We weren’t afraid to ask for help for ourselves and the people we care about?  We no longer had to feel ashamed of feelings of despair and hopelessness, but recognized them as symptoms of a brain disorder?

44. August 15Gatekeeper Training44 WHY DON’T WE HELP?  Most of us are afraid of getting a “yes” answer if we ask about suicide. We think we don’t know how to help.  Some of us believe that suicide and depression are not our business or responsibility. Remember that most suicidal people are very ambivalent. They want help for the pain but don’t know how to ask for it.

45. August 15Gatekeeper Training45 A METHOD WE CAN USE Dr. Paul Quinnett suggests learning QPR, similar to CPR: Question Persuade Refer for those times when we realize that someone needs help for dealing with their pain but they don’t know how to ask for it.

46. August 15Gatekeeper Training46 ASK QUESTIONS…BE CURIOUS  “You seem pretty down today.”  “Do things seem hopeless to you?”  “How do you plan to deal with your problem?  “Are you thinking about suicide?” If you get a “yes” answer, ask more questions.

47. August 15Gatekeeper Training47 HOW MUCH RISK IS THERE? To find out if the person is in immediate danger. Ask or think about…  Has the person attempted suicide before?  Does the person have a plan?  How specific is the plan?  Does the person have access to means of suicide?

48. August 15Gatekeeper Training48  Do remain calm, relaxed and rational.  Do look and listen for warning signs and get help early.  Do get involved and stay involved.  Do talk openly about suicide and encourage expression of feelings.  Do get the person to explain what hurts so badly. DO…

49. August 15Gatekeeper Training49  Do listen with empathy; show interest and support.  Do take action and remove means.  Do offer hope that alternatives are available.  Ask if they ever felt like this before and how they got through that situation. DO

50. August 15Gatekeeper Training50 DON’T..  Don’t make moral judgments.  Don’t argue, lecture, or encourage guilt.  Don’t be sworn to secrecy or make promises you can’t keep.  Don’t offer empty reassurances (“You’ll get over this”).

51. August 15Gatekeeper Training51  Don’t minimize the problem (“All you need is a good night’s sleep”).  Don’t keep the information secret.  Don’t dare or use reverse psychology.  Don’t leave the person alone.

52. August 15Gatekeeper Training52 Never Go It Alone  Family/friends  School personnel  Emergency room staff  Law enforcement  Family doctor  Mental health professionals  Clergy  Crisis hotlines Collaborate With Others

53. August 15Gatekeeper Training53 Community Resources  Know how and where to get help before a crisis happens. Have a resource list.  Find out who to go to in your agency or school.  Refer the person for professional help and help them get there.  For immediate danger, call 911 for help from the police and/or paramedics. Ask if there is a Crisis Intervention Team (CIT) officer available.

54. August 15Gatekeeper Training54 If person is not in immediate danger and can be safely transported, take them to:  Children’s Hospital Medical Center (under age 18)  Any hospital emergency room or Portage Path Emergency Services (over age 18) For guidance and support: crisis hotlines (24/7) :  SUPPORT Hotline (Summit County) (330) 434-9144  Lifeline (From Anywhere) (800) 273-TALK  PIRC Program (Children’s Hospital) (330) 543-7472

55. August 15Gatekeeper Training55 FINAL THOUGHTS  You may know people with depression.  Have an open discussion about depression and suicide. Invite them to talk.  You would perform CPR if you saw a heart attack victim, remember QPR for suicide emergencies.  Don’t be afraid to “interfere” when someone is dying more slowly of depression.

56. August 15Gatekeeper Training56 BECAUSE OF YOUR POSITION  You might be the only person who recognizes that a person needs help.  Follow your “gut reaction.”  Help reduce the stigma placed on mental illness, suicide and depression.  Be aware of your own vulnerability to depression.

57. August 15Gatekeeper Training57 THE MOST IMPORTANT THING YOU CAN DO IS TO INSTILL A FEELING OF HOPE THAT THE PERSON WILL GET THROUGH THIS ROUGH TIME.

58. August 15Gatekeeper Training58 A PERSON MAY NEVER HAVE EXPERIENCED A DIFFICULT TIME PREVIOUSLY AND SO THIS MAY FEEL LIKE THE END OF THE WORLD. DON’T LET IT BE.

59. August 15Gatekeeper Training59 THANKS SO MUCH FOR ALL YOU DO EVERY DAY TO MAKE THIS A BETTER WORLD FOR PEOPLE IN THESE TURBULANT TIMES. The world is a better place because you care.