1. An American Epidemic: An American Epidemic: Practical and Clinical Considerations of Suicide

2. A word of caution… I consider this topic to be the most important of the semester. That being said, it can be a sensitive topic and you should not feel obligated to remain in class if you are uncomfortable. I consider this topic to be the most important of the semester. That being said, it can be a sensitive topic and you should not feel obligated to remain in class if you are uncomfortable.

3. Activity Time! Take out a piece of paper and answer “True” or “False” for the following statements Take out a piece of paper and answer “True” or “False” for the following statements 1. Suicide is less common than murder. 1. Suicide is less common than murder. 2. We should be gentle or tentative when approaching someone we think may be suicidal. 2. We should be gentle or tentative when approaching someone we think may be suicidal. 3. Once someone is intent on committing suicide, there is no way to stop them. 3. Once someone is intent on committing suicide, there is no way to stop them. 4. Psychologists and psychiatrists are the only people who can help someone who is suicidal. 4. Psychologists and psychiatrists are the only people who can help someone who is suicidal. 5. Suicidal people are only seeking attention. 5. Suicidal people are only seeking attention. 6. Depression causes all suicides. 6. Depression causes all suicides.

4. Stats and Facts 1. 7 th or 8 th leading cause of death overall in the last decade 2. 2 nd or 3 rd leading cause of death for adolescents and young adults 3. Most prevalent in adolescents and older adults 4. Twice as common in college students than non- college counterparts 5. Accounts for about 30-33,000 deaths annually 6. Women more likely to attempt, men more likely to complete 7. Suicidal thoughts and attempts difficult to count

5. What would you do? Fred is a loved one who has made references to death and disappearing of late. You also notice he exhibits signs of depression. Fred is a loved one who has made references to death and disappearing of late. You also notice he exhibits signs of depression. 1. How would you handle this situation? 1. How would you handle this situation? 2. What if he had a plan? 2. What if he had a plan?

6. Risk Factors/Causes 1. Mood disorder 1. Mood disorder 2. Gender 2. Gender 3. Negative Life Event 3. Negative Life Event 4. Neuroticism 4. Neuroticism 5. Low self-esteem 5. Low self-esteem 6. Low social support 6. Low social support 7. Personality Disorder 7. Personality Disorder **Most likely completed when mood is improving **Most likely completed when mood is improving

7. Warning signs 1. Talking about dying 2. Recent loss 3. Depressive symptoms 4. Talking about loss of control/harming self or others 5. Withdrawal from relationships 6. Hopelessness 7. Previous attempt** 8. “Finalizing behavior” (e.g., Giving things away, tying up relationships, making out wills)

8. What can you do? 1. Educate yourself on warning signs 1. Educate yourself on warning signs 2. Be direct 2. Be direct 3. NEVER leave the person alone 3. NEVER leave the person alone 4. Assess immediacy of threat – plan and means? Remove if needed 4. Assess immediacy of threat – plan and means? Remove if needed 5. GET HELP!!! 5. GET HELP!!! –University Counseling Center 348-3863 348-3863 –University Psychological Clinic 348-5000 348-5000 –1-800-273-TALK –UAPD 348-5454 348-5454 –DIAL 911

9. So, we’ve reviewed the practical issues concerning suicide… Let’s chat about the controversies… Let’s chat about the controversies…

10. Thomas Szasz and the (Im)morality of suicide Argues that suicide prevention is: Argues that suicide prevention is: Immoral Immoral Impractical Impractical Can treat underlying conditions Can treat underlying conditions What do you think? What do you think?

11. Physician-Assisted Suicide Jack Kevorkian assisted in roughly 100 assisted suicides Jack Kevorkian assisted in roughly 100 assisted suicides Created machine to induce unconsciousness and deliver a lethal dose of potassium chloride Created machine to induce unconsciousness and deliver a lethal dose of potassium chloride

12. The Death and Dignity Act Oregon was the first state to make assisted suicide legal in 1994 Oregon was the first state to make assisted suicide legal in 1994 Act requires 2 physicians to clear: Act requires 2 physicians to clear: A. less then 6 months to live A. less then 6 months to live B. not suffering from mental illness B. not suffering from mental illness

13. Medical stance on assisted suicide AMA is against assisted suicide. AMA is against assisted suicide. However, BMA surveys show interesting results! However, BMA surveys show interesting results!

14. Let’s debate! What are the pros and cons of assisted suicide? What are the pros and cons of assisted suicide?

15. Suicide from the clinician’s perspective Basic Terms: Basic Terms: 1. Deliberate self-harm without intent 1. Deliberate self-harm without intent 2. Suicide attempt 2. Suicide attempt 3. Risk and protective factors 3. Risk and protective factors 4. Self injurious behavior 4. Self injurious behavior 5. Suicidal ideation 5. Suicidal ideation –Active vs. passive

16. Steps in a typical suicide risk assessment Question: Imminent risk of death vs. non-fatal attempts? Question: Imminent risk of death vs. non-fatal attempts? 1. Allow person to discuss their problem for 5-10 minutes 1. Allow person to discuss their problem for 5-10 minutes 2. Assess negative psychological effects of problem (e.g., hopeless, depressed) 2. Assess negative psychological effects of problem (e.g., hopeless, depressed) 3. Assess thoughts of suicide uninterrupted  thoughts at the moment 3. Assess thoughts of suicide uninterrupted  thoughts at the moment 4. Assess thoughts of death- active or passive? 4. Assess thoughts of death- active or passive? 5. Ask about carrying out plan/taking other with them 5. Ask about carrying out plan/taking other with them

17. Considerations in risk assessment Validate feelings, but convey options Validate feelings, but convey options Risk and protective factors approach Risk and protective factors approach –See handout Low, Medium, High Risk Low, Medium, High Risk –No clear cut off –Clinical judgment

18. Activity Time: Forming a Risk Prediction and Action Plan Dr. Phil is out of the office because he was arrested for stupidity Dr. Phil is out of the office because he was arrested for stupidity Help him out by pairing up and using the risk and protective factors sheet to: Help him out by pairing up and using the risk and protective factors sheet to: A. Make a suicide risk judgment about the following case A. Make a suicide risk judgment about the following case B. Based on your judgment, propose ideas for immediate treatment B. Based on your judgment, propose ideas for immediate treatment We’ll discuss! We’ll discuss!

19. Poor Bucky… Bucky is a 22 year-old male graduate student who came to see you complaining of active suicidal thoughts, depression, excessive alcohol use, and talking of using his father’s rifle. He has never attempted suicide, but has a long history of suicidal thoughts and psychiatric treatment. A comprehensive evaluation of his background showed he recently lost his best friend in a car accident, has an uncle who committed suicide, and he suffered physical abuse as a child. Bucky noted feeling guilty because suicide goes against his strong family ties and devout religiosity. Bucky noted having 5 or 6 close friends, but has withdrawn from them. He has discussed plans for the upcoming week in which he will take part in a university concert. Bucky ends the session by telling you he wants to feel better, but does not know what to do. Bucky is a 22 year-old male graduate student who came to see you complaining of active suicidal thoughts, depression, excessive alcohol use, and talking of using his father’s rifle. He has never attempted suicide, but has a long history of suicidal thoughts and psychiatric treatment. A comprehensive evaluation of his background showed he recently lost his best friend in a car accident, has an uncle who committed suicide, and he suffered physical abuse as a child. Bucky noted feeling guilty because suicide goes against his strong family ties and devout religiosity. Bucky noted having 5 or 6 close friends, but has withdrawn from them. He has discussed plans for the upcoming week in which he will take part in a university concert. Bucky ends the session by telling you he wants to feel better, but does not know what to do. Assign Bucky a risk level Assign Bucky a risk level Generate some ideas for treatment Generate some ideas for treatment

20. Immediate treatment options/considerations Involving family/friends Involving family/friends –Confidentiality considerations –Support system Medication evaluation Medication evaluation Inpatient or outpatient therapy Inpatient or outpatient therapy Crisis Response Plan vs. “No suicide contract” Crisis Response Plan vs. “No suicide contract” Hospitalization Hospitalization –Duty to protect