Presentation is loading. Please wait.

Presentation is loading. Please wait.

1 Suicide Prevention: SOS, Classroom Activities, and Other Evidence-Based Strategies NASP 2010 3/2/10 12-1:50pm Adam Grieve, MS University of Wisconsin-Madison.

Similar presentations


Presentation on theme: "1 Suicide Prevention: SOS, Classroom Activities, and Other Evidence-Based Strategies NASP 2010 3/2/10 12-1:50pm Adam Grieve, MS University of Wisconsin-Madison."— Presentation transcript:

1 1 Suicide Prevention: SOS, Classroom Activities, and Other Evidence-Based Strategies NASP 2010 3/2/10 12-1:50pm Adam Grieve, MS University of Wisconsin-Madison John Humphries, MSE, NCSP School Psychologist, WI Department of Public Instruction

2 2 About this presentation Lots of info on a tough topic Recognize your own feelings Ask questions, share your experiences Stigma-free environment

3 3 Primary Objectives for the day Understand suicide as both a public health issue and a problem of individual mental health Identify risk factors and warning signs Learn two evidence based strategies for intervention: ACT and QPR Contextualize suicide prevention strategies within in a three-tiered prevention framework Leave with supplemental information about: Classroom Instruction Gatekeeper Training Crisis Response

4 4 Language Notes: Suggestions from Survivors Do use: Completed Suicide Died by Suicide Took his/her own life Died of Suicide… Dont use: Successful Suicide Attempt Committed Suicide its not illegal

5 Is suicide very common? From 1999-2007 (9 yrs.)Deaths Age 10-19 Motor Vehicle Accidents1055 Homicide301 All Cancers201 Accidental Drowning78 Accident/Undet. Firearm35 Fire/Smoke Inhalation19

6 6

7 7 Which gender is most at risk? 349 males 85 females > 4:1 ratio of males to females

8 8 What is the most common method? (WI) Firearms: 215 deaths (>50% of total) 191 males, 24 females (8:1) Hanging/Suffocation: 167 cases (40%) 124 males, 43 females (<3:1) Poisoning: 22 cases (5%) 13 males, 9 females Falls: 9 cases 8 Males, 1 Female 21 Others: Transport, Cut, Drown, Burn

9 9 Trends in the method In WI, suffocation is still most common for females and firearms for males (DHS WISH, 1999-2007) National trend is that suffocation has become the most common method for all groups except males 15-19, where firearms still most common (CDC WISQARS)

10 10 Firearms and Hanging: most lethal Firearm Case Fatality Rate=91% Firearms/Hanging= 10% of acts, 67% fatalities Poisoning= 74% of acts, 7% of fatalities Miller M, Azrael D, Hemenway D. The epidemiology of case fatality rates for suicide in the northeast. Ann Emerg Med. 2004 Jun;43(6):723-30. All ages, a Northeastern US Hospital, 1996-2000

11 11 Of all deaths among youth… In the U.S. Suicides are 12% Third leading cause of death In Wisconsin Suicides >17% Second leading cause of death WISQARS, Centers for Disease Control and Prevention, National Center for Health Statistics (NCHS), National Vital Statistics System, downloaded 3/19/08 for years 1999-2005, ages 10-19

12 12 Under-report? Nonetheless, youth suicide probably is underreported because of social stigma, shame, and guilt among family and friends Estimates of official underreporting of suicide by medical examiners have ranged from 25% to 50%. Jobes, et. al 1991, and Rosenberg et. al., 1988, as cited by King, K. A., The Prevention Researcher 13(3), Sept 2006, p. 8-11

13 13 How does WI compare with USA? 1999-2005 Ages 10-19, Suicide Rate per 100,000 Range 2.3 (NJ) to 18.9 (AK) US Rate 4.5/100,000 WI 13 th highest rate in nation: 6.41 WI Rate 42% higher than the national rate MN: 18 th, IL: 44 th Others like WI include IA, WV, OK, AZ www.cdc.gov/ncipc/wisqars retrieved 03/19/08

14 State Youth Suicide Rate Comparisons 1999-2005, Ages 10-19 (CDC WISQARS) Wisconsin Illinois

15 15

16 16 Why Do States Differ? Some Guesses Drinking: lower inhibition, alter judgment WI: Highest rate of youth binge drinking in US Guns WI: 12 th highest gun ownership rate43% (2001) Mental Health Service Availability 8.2 Child/Adolescent Psychiatrists/100,000 youth vs. recommended 14 Stigma Climate Coordinated public health and educational efforts Legislation 2007 YRBS as cited in Miller, 2005 Moreno, C. et. al. (2007) Arch. Gen Psychiatry 64:1032-1039

17 17 It takes: Understanding Planning Commitment Resources Sustained Effort

18 18 Does depression matter academically? Schools with more students who report being sad or hopeless make less progress in raising test scores than other schools Ensuring That No Child Is Left Behind: How Are Student Health Risks & Resilience Related to the Academic Progress of Schools 2004 Data Source: California Healthy Kids Survey & STAR data files. www.wested.org/chks/pdf/p1_stuartreport_ch_final.pdf

19 19 Statistics tell a story, and can help us know when, how and where to intervene About one youth each week (WI) Suicide is 2 nd leading cause of death WI rate is >40% higher than US average More boys die than girls Girls report more attempts (YRBS) More girls report depression Method: guns, hanging Gay/Lesbian kids at high risk

20 20 Next Steps for this section Risk factors Direct Related Warning Signs: Early & Late Other related issues Medications Repetitive Self-Harm (Cutting) The suicide equation Protective Factors

21 21 Risk Factors Direct Suicide-Risk Factors are most strongly associated with suicidal behaviors among youth: A prior suicide attempt (strongest predictor, 8X rate of no prior attempt) Suicide threats & ideation Detailed intentions for an attempt Eggert, L., 2002. Best Practices for School-Based Youth Suicide Prevention, WI DPI. Lewinsohn et al., 1994, as cited in Langhinrichsen-Rohling, J et al., Suicide and Life Threatening Behavior 38(4), August 2008

22 22 Exposure to Suicide is a Risk Factor Direct Exposure Youth who have family members who attempt suicide or die by suicide show high levels of at- risk behaviors, especially suicide ideation and attempts (J. Adol. Health 2005; 36 (4): 352) Indirect & Media Exposure Extensive coverage of suicide in media leads to increases in suicide attempts among vulnerable populations (youth, prior attempt) Two recent suicides received national attention (J. Clinical Psychiatry 2007; 68: 862-866)

23 23 Related Suicide Risk Factors Serious depression, hopelessness Alcohol Use & Drug involvement Stressful life events Family conflicts Risky or impulsive behaviors (police) School problems (perceived problems) Perceived overweight or underweight Cognitive (Problem-Solving) Skills Repetitive self-harming behaviors J. of Adolescence, 29 (2005) 75-87; Arch Pediatr Adolesc Med. 2005;159:513-519; J. School Health, 77, 2, 59-66

24 24 Related Risk FactorsMental Illness Completed Suicide and Psychiatric Diagnoses in Young People… 89% had a diagnosed mental illness 40% had substance abuse disorder Fleischmann, et. al., Amer. J. Orthopsychiatry, 75; 4, 2005

25 25 Alcohol/Sedatives and Suicide Dis-inhibiting Alters judgment Can trigger aggression Increases impulsivity Sedating Ataxia (falls, injuries) Coma-inducing Michael Miller, Meriter, 9/22/08, Eau Claire Suicide Prevention Summit

26 26 Suicide Early Warning Signs Withdrawal Preoccupation with death Marked personality change & serious mood changes Difficulty concentrating Decline in quality of school work Change in eating habits Change in sleep patterns important marker Youth Suicide Prevention School-Based Guide, 2003, Louis de la Parte Florida Mental Health Institute Goldstein, et. al, J Consulting Clinical Psychiatry, 2008 Feb; 76(1): 84-91

27 27 Early Warning Signs Loss of interest in favorite activities Frequent complaints about physical symptoms, often related to emotions (stomachaches, headaches, fatigue) Persistent boredom Youth Suicide Prevention School-Based Guide, 2003, Louis de la Parte Florida Mental Health Institute

28 28 Late Warning Signs Talking about suicidespecific plans Impulsive or violent actions, rebellious behavior, or running away Refusing help or feeling beyond help Claiming to be a bad person Hopelessness, helplessness, or worthlessness Youth Suicide Prevention School-Based Guide, 2003, Louis de la Parte Florida Mental Health Institute

29 29 Late Warning Signs Being intolerant of praise or rewards Making statements that hint at or directly imply suicide Being suddenly cheerful after a period of depression Giving away favorite possessions Making a last will & testament Youth Suicide Prevention School-Based Guide, 2003, Louis de la Parte Florida Mental Health Institute

30 30 WARNING: IS PATH WARM? I Ideation S Substance Abuse P Purposelessness A Anxiety/Agitation T Trapped H Hopelessness W Withdrawal A Anger R Recklessness M Mood Changes See/order Risk Assessment Initial Tips for Counselors FREE Suicide Lifeline Materials Order Form American Association of Suicidology, 2006, Expert Consensus Statement

31 Another helpful acronym…FACT Feelings Hopelessness, fear of losing control, going crazy, overwhelmed, shamed, pervasively sad, persistent anxiety or anger Actions or Events Drug/Alcohol abuse, themes of death/destruction in spoken or written material, recent loss, agitation, aggression, recklessness Change More withdrawn, tired, apathetic, lack of concentration, change in sleep patterns, loss of interest friends, hobbies, sudden improvement after a low period Threats Statements about death, plans, suicidal gestures or attempts, putting things in order, giving away prized possessions

32 32 Impulsivity and Means Restriction 25% of 153 survivors of near lethal suicide attempts acted within 5 minutes of the impulse to do so 71% acted within one hour Factors associated with the medical severity of suicide attempts in youths and young adults, Swahn MH, Potter LB, 2001 Suicide Proneness and Adjudicated Adolescents, Langhinrichsen- Rohling, J et al., Suicide and Life Threatening Behavior 38(4), August 2008

33 Whose gun do kids use? 85% of youth under 18 who died by firearm suicide used a family members gun, usually a parents. Harvard Injury Control Research Center, National Violent injury Statistics System (NVISS). 2001 suicide data summary. We promote 4 safe storage strategies: trigger locks/cabinets store guns unloaded lock ammunition lock guns and ammo in separate locations (Grossman, JAMA 2/9/05) 33

34 34 Precipitating Factors Opportunities access to a gun (WI Tradition)… periods without supervision Altered states of mind rage intoxication--binge drinking high correlate (2007 YRBSWI had highest rate of binge drinking of all states) Undesirable life events loss of an interpersonal relationship pregnancy/fear of pregnancy physical & sexual abuse humiliation (bullying) or reprimand…

35 35 The Suicide Equation Previous Mental Illness (Depression) + Stressor (Loss, etc.) + Opportunity (Firearm, Unsupervised Time) Possible Suicide Attempt? ________________________________________________________

36 36 Protective Factors Important social resources strong interpersonal bonds social support sense of belonging dominant attitudes & values prohibit suicide Important personal resources strong sense of self-worth & self-esteem good cognitive skills sense of personal control self-management skills to deal with stress, anger and depression

37 37 We add ACT as a protective factor A is for Acknowledge signs and symptoms, dont minimize their feelings C is for showing Care and Concern for the person who is at-risk T is for Tell a trusted adult who knows how to respond, including pupil services, heath educators, or administrators in your school

38 ACT: Video Part of SOS classroom curriculum Applicable for students as well as staff/parents/community members Reactions? Video strengths/weaknesses?

39 Signs of Suicide (SOS) Source of ACT New Middle School Materials complement HS Good evidence base, NASP supported DPI Curriculum uses their video Materials for students, parents and staff Screening forms Enough materials for 300 students, $300 Each CESA has at least one MS and one HS kit Step 2: Order SOS using form on the CD

40 QPR (qprinstitute.com) Question Ask if the person has had any thoughts, feelings, or plans about suicide or self-harm Ask clarifying questions NOT: Youre not thinking about suicide, ar you? Persuade Persuade the person to get help. Listen carefully and say, Let me help or Come with me to find help. Refer Refer for help. Personally escort the person to the resource Requires awareness of local help resources

41 Gatekeeper Training Goal: To enhance the probability that a potentially suicidal person is identified and referred for assessment and care before an adverse event occurs The most likely person to prevent you from taking your own life is someone you already know.

42 Gatekeeper Training Signal Detection Theory Gatekeeper does not respond Gatekeeper does respond Warning Sign Present MissHit Warning Sign Absent Correct RejectionFalse Alarm

43 43 Increasing Dose of Preventive Interventions Universal Target General Population Universal Target General Population Selected Target High-Risk Groups Selected Target High-Risk Groups Targeted Target High-Risk Individuals Targeted Target High-Risk Individuals Solid Protective Factors Few Risk Factors Suicide-risk Behaviors Related Risk Factors Weak Protective Factors Low Risk Increasing Predisposition For Suicidal Behaviors

44 44 Universal General Population Public Education Gatekeepers Classroom Education Means Restriction Media Education Screening Universal General Population Public Education Gatekeepers Classroom Education Means Restriction Media Education Screening Selected High-Risk Groups Screening Part 2 Skill-building Groups Crisis Teams Selected High-Risk Groups Screening Part 2 Skill-building Groups Crisis Teams Targeted High-Risk Individuals Skills Groups Parent Support Case Management Community Referrals Suicide Risk Assessment Targeted High-Risk Individuals Skills Groups Parent Support Case Management Community Referrals Suicide Risk Assessment For each intervention level, model strategies are: A comprehensive suicide prevention plan includes strategies from each level

45 On CD: All slides of todays presentation, among others DPI Middle and High School suicide prevention curriculum Information regarding suicide crisis response SOS order form (DPI/UW does not have a financial tie to SOS)


Download ppt "1 Suicide Prevention: SOS, Classroom Activities, and Other Evidence-Based Strategies NASP 2010 3/2/10 12-1:50pm Adam Grieve, MS University of Wisconsin-Madison."

Similar presentations


Ads by Google