Suicide Prevention Training for Non-Health Staff What to Look For What to Say How to Respond

Objectives  List three risk factors for suicide  Identify three suicide warning signs  State a direct and indirect approach to asking about suicide  Identify two ways to persuade someone to get help  Identify your referral sources 1

Why is this Training for Non-Health Staff?  Most Suicidal Youth…  Don’t self-refer to treatment  Go undetected by mental health professionals  Go untreated Suicidal youth are most likely to be prevented from suicide by someone they know well or see daily… 2

Suicidal Individuals Often Provide Warning Signs  We often don’t notice due to lack of information, fear, and denial. 3

Save Lives By…  Learning warning signs  Knowing how to ask about suicidal thoughts  Persuading person to get help  Knowing referral resources 4

Suicide Impacts All of Us 5

CDC National Youth Risk Behavior Survey (2009)  26.1% youth reported symptoms consistent with MDD in previous 12 months  Approximately 14% had seriously considered attempting suicide  Approximately 11% had made a plan for how they would attempt suicide  Over 6 % of youth reported having attempted suicide (once or more) 6

7 True or False? Males complete suicide five times more often than females.

True. Male Rate is 5X Higher. Method Used% Male% Female Firearms5630 Suffocation/ hanging 2421 Poisoning1340 8

9 True or False In PY2010, the rate of suicide for JC students was higher than the national rate.

False. JC Rate is Much Lower. JC PY2010: Death TypeJob Corps Rate per 100,000 National Rate per 100,000 Unintentional Injury Suicide Homicide

11 True or False? No one can stop a suicide. Suicidal people keep their plans to themselves.

False. In Many Cases Suicide is Preventable.  Most suicidal people communicate their intent before committing suicide  For most, suicide is a permanent solution to a temporary/treatable problem  Personal crisis, unrelenting stress or depression, sense of failure and/or loss 12

Who is at Risk?  Mental disorders (especially depression)  Alcohol and other substance use disorders  Person with easy access to lethal means  History of trauma/abuse  Prior suicide attempt/family history suicide  Sense of hopelessness  Impulsive/aggressive tendencies  Sense of isolation/lack social support  Exposure to suicide (glorified) 13

Suicide Warning Signs: Direct Verbal Cues  “I’ve decided to kill myself”  “If X doesn’t happen, I’ll kill myself”  “I want to kill myself” Indirect Verbal  “I’m tired of life”  “Who cares if I’m not around?”  “I don’t see any point in going on”  “It has been good knowing you” 14

Suicide Warning Signs: Behavioral Clues  Changes in behavior or mood  Withdrawal from friends/supports  Lack of interest  Decline in academics/vocation  Eating, sleep, physical problems  Depression (sadness/tearfulness)  Self-mutilation or risk taking behavior  Fixation with death/violence  Mood swings/aggression/agitation 15

Suicide Warning Signs Situational Clues  Relationship breakup  Recent disappointment  Disciplinary problems  Alienated from family/culture  Victim of bullying/assault  Humiliating event  Unhealthy peer relationships (switch in peers) 16

When Concerned, Ask the Question …  You don’t need to become a therapist to ask about suicide  How you ask is less important than that you ask 17

Tips for Asking about Suicide  If you are concerned, don’t wait!  Find a private place to talk  Allow person to talk freely: don’t interrupt (use your listening skills)  If person is reluctant, be persistent in showing you care and want to help 18 QPR Institute:

Asking About Suicide  Acknowledge the person’s distress  “I’ve noticed you’ve seemed less interested in your work and you’ve been spending more time alone.”  “Coming to JC can be really hard and a lot of students miss their families. I’m worried about you because you’ve seemed really down.” 19 QPR Institute:

Asking About Suicide  Less Direct Approach  “Have you been unhappy lately?”  “Have you ever been so unhappy that you wished you were dead?”  “Do you ever wish you could go to sleep and not wake up?”  “Sometimes when people are really upset and overwhelmed they wish they were dead. Do you feel that way?” 20

Asking About Suicide  Direct Approach  Are you having thoughts about killing yourself?  Do you wish you were dead? Have you been thinking about ending your life?  Are you thinking of killing yourself? 21

Asking About Suicide 22  DON’T SAY:  “You’re not thinking about killing yourself are you?”  Ask in a way that allows person to answer in positive

Listen and Persuade 23  Actively listen  Be attentive  Don’t interrupt  Don’t condemn suicide  Don’t judge  Quiet your own fears What are the problems that seem escapable only through suicide?

Listen and Persuade 24  Focus on solutions to problems  Offer hope in any form  Accept the pain experienced while offering alternatives to suicide  “I care about you and I want to take you to the Wellness Center to get more help…”  “Will you let me make you an appointment with…”  “Will you promise me...”

Referral Sources 25  Student’s Counselor  Health and Wellness Center  CMHC and other staff trained in suicide assessment  Supervisor or HWC Person on Call (if after hours or on weekends)  Know the Symptomatic Management Guideline for Non-Health Staff for Suicide Attempts/Threats  Know your center’s SOP/COP for suicide risk assessment  Local Resources  Local crisis line  Suicide Prevention Lifeline:  TALK

Team Approach Best  Get others involved  Who needs to be involved for safety  Safety assessment trumps confidentiality rights  Are there other people the individual wants contacted for support (family, etc.)  Work as a team to provide continued support 26

What if Person Won’t Agree to Get Help?  If you are concerned someone is suicidal...  Don’t worry about breaking trust or being disloyal  Don’t worry that you may not have “enough” information to call for help  Get help! 27

Scenarios 28

Malik  Malik is 22 year-old African American male who has been at Job Corps for three months. While surfing Facebook he learned that his girlfriend back home is involved in another relationship. After that, Malik gets a positive suspicion test for alcohol and is placed in TEAP. He used to play on the center basketball team, but is now refusing to go to the gym or play. One evening he gets into a heated verbal argument with his roommate and is now going before the CRB. He has stopped talking much with staff or students. A couple of days later he hangs himself in an abandoned building on center.

What’s the Best Response?  Given that you knew Malik, and were aware of his distress, which of the following would be the best response? 1. Wait and see how things go because relationship stuff happens all the time at Job Corps. He will get over it and find a new one here. 2. If I knew about his girlfriend problems, I would talk to him to see if he was alright. I would ask him if he felt suicidal. If he said yes, I would escort him to see the Counselor or stay with him until I could get someone from Wellness. 3. Because of his alcohol abuse and current relationship with the TEAP Specialist, I would inform the TEAP Specialist that something was troubling Malik. I would suggest that the TEAP Specialist talk to him. 30

Morgan  Morgan is an 18 year-old, White gay female, who was only able to finish the 8 th grade. Morgan has difficulties learning new skills and can’t seem to pass the GED. Because of what appears to be her “slowness,” and outward appearance she is often ridiculed by peers and sometimes staff. Everyone believed that she accepted the treatment as good natured ribbing. Prior to her death she gave away some personal belongings. About one day before her death, she also told a buddy that she had “had enough.” This was interpreted as simple frustration. Morgan shot herself in the parking lot of a nearby school.

What’s the Best Response?  Given that you know Morgan, and aware of her distress, which of the following would be the best response? 1. If I had known she was angry about being “teased,” I would talk to her to see if she was alright. I would ask her if she felt suicidal. If she said yes, I would convince her to see the CMHC in the morning. After she made a commitment, I would tell her that I would go with her the next day. 2. In Job Corps, students and staff are always joking with each other. That’s how we all deal with the stress. If you can’t handle the ribbing, you should probably not be at Job Corps. 3. When I heard that she had had enough, I would immediately ask her if she was thinking of suicide. If she said yes, I would stay with her, and inform my supervisor. I would never leave her alone until she saw a counselor or someone from the Health and Wellness Center. 32

John  John is a 19-year-old White male and is close to graduating from Job Corps. He came in as a homeless student. He had difficulty learning in the trade and some disciplinary problems but he will graduate in about 4 weeks. A couple of days ago, he received a call from his mother saying that he can’t come live with her and he got really upset. You approach John and he states that no one understands him, things never get better, and that his life is crap.  What do you do next and why? 33

Role Play 34  Five Minutes Each Role  One person play John  One person play helper  Switch Role

How to Help John Acknowledge distress…  Right now it feels like nothing is going right for you…  You’re not sure how all this is going to work out… Ask the Suicide Question…  Indirect: sometimes when life feels like crap people wish they could go to sleep and not wake up. Have you been feeling that way?  Direct: Are you having thoughts of killing yourself? 35

Listen and Persuade… 36  Listen  What are the problems that seem escapable only through suicide?  Persuade  Accept the person’s pain while providing hope and possible solutions to problems…

Remember………. Suicide is NOT the problem Suicide is only the solution to a perceived insoluble problem that is no longer tolerable