Depression and BiPolar Support Alliance When Suicide Becomes an Option Donna Holland Barnes, PhD Howard University NOPCAS, Inc

Agenda Review the literature General statistics Suicide Myths and Facts Clues to look out for Assessing and Managing Suicidal Risk Q & A

Review of the literature Anywhere from 25-50% of patients with bipolar disorder have attempted suicide and, between 10 – 15% eventually die by suicide (Jamison, 2000; Pillmann, eet al, 2001; Rihmer, 2002; Mitchell, 2004) Multiple suicide attempts are common among BP patients (Michaelis, 2003) Treatment with Lithium is associated with reduced suicidal risk (Baldessarini, 2001; Sharma, 2003)

Literature Review (continued) Widespread underdiagnosis and undertreatment of major depression and BP disorder contribute to an unacceptable risk of suicide (Nierenberg et. al, 2001;Lindemann et al, 1999) Many of those diagnosed with BP are not on mood stabilizers and more effort is needed to do a better job in treatment (Shi et al,2004)

Literature Review (continued) Co-occurence alcoholism is associated with a higher rate of attempted suicide among family members with BP and oftentimes triples the risk (Potash et al, 2000; Comtois, 2004) For the majority population, attempts among those with BP generally occur before the age of 25, attempting at a relatively young age (Lopez P. et al, 2001)

General Statistics In 2005, we had 32,637 suicides (11.0) 23,478 white males (19.7) 6,049 white females (5.0) 2,429 nonwhite male (9.0) 681 non white female (2.3) 1,621 black males (8.7) 371 black female (1.8) 2,188 Hispanic (5.1) 392 Native American (12.4) 796 Asian/Pacific Islanders (5.2)

So where does this leave us?

Suicide Myths and Facts MythNo one can stop a suicide, it is inevitable. FactIf people in a crisis get the help they need, they will probably never be suicidal again. Myth Confronting a person about suicide will only make them angry and increase the risk of suicide. FactAsking someone directly about suicidal intent lowers anxiety, opens up communication and lowers the risk of an impulsive act. Myth Only experts can prevent suicide. Fact Suicide prevention is everybody’s business, and anyone can help prevent the tragedy of suicide

Myths And Facts About Suicide MythSuicidal people keep their plans to themselves. FactMost suicidal people communicate their intent sometime during the week preceding their attempt. Myth Those who talk about suicide don’t do it. FactPeople who talk about suicide may try, or even complete, an act of self-destruction. Myth Once a person decides to complete suicide, there is nothing anyone can do to stop them. Fact Suicide is the most preventable kind of death, and almost any positive action may save a life. How can I help? Ask the Question...

Indirect verbal clues “I’m tired of life, I just can’t go on.” “My family would be better off without me.” “Who cares if I’m dead anyway.” “I won’t be around much longer.” “Pretty soon you won’t have to worry about me.” “I keep messing up.” “I am really not that important.”

Behavioral Clues: Any previous suicide attempt Acquiring a gun or stockpiling pills Co-occurring depression, moodiness, hopelessness Putting personal affairs in order Giving away prized possessions Sudden interest or disinterest in religion Drug or alcohol abuse, or relapse after a period of recovery Unexplained anger, aggression and irritability

Situational Clues: Being fired or being expelled from school A recent unwanted move Loss of any major relationship Death of a spouse, child, or best friend, especially if by suicide Diagnosis of a serious or terminal illness Sudden unexpected loss of freedom/fear of punishment Anticipated loss of financial security Loss of a cherished therapist, counselor or teacher Fear of becoming a burden to others

Assessing and Managing Suicidal Risk

How do we know what we know? Assessment is based on: How much we learn from the person The context in which suicide is being considered Recognition of warning signs Presence of risk factors Presence of protective factors What the suicidal person is willing to do to help us save his or her life

Relationship is Everything! How much we learn depends on how much they like us, and how much we like them. Don’t let them tick you off to prove they can’t be helped. Find something to like. YOU HAVE TO REMAIN HOPEFUL ABOUT THE FINAL OUTCOME!

Why Now Questions Things have been bad for a long time, what’s happened recently? What’s changed so much that you’re now thinking about suicide? Why now? Why are you thinking about killing yourself today?

WITH WHAT? Elicits methods of suicide under consideration Only so many ways to die How? (name them) Access to means? More than one method? Degree of lethal planning? Backup plan?

Who’s Involved Sample Questions Who’s important to you? Who else knows you’re in this much pain? Who is your main support? Who could help right now? Who needs to know about your troubles? Who have you told about your suicidal thinking?

Who’s involved? Elicits social psychological context It usually takes two Who won’t/can’t help? Who can make it worse? Who cares and can make it better? Professionals involved? Double suicide pact? Murder-suicide?

When and With What in the Past? Elicits important suicide history Past attempts? Past suicidal ideation? Rescue sought or avoided? Timing of attempt? Social response to attempt? What saved them? New method vs. old method?

Why Not Now? Elicits protective factors Reasons for living? Spiritual or religious prohibitions? Duties to others/pets? Tidying up or ‘to list’ before dying? Fear of death? More reasons is good, none is bad Low risk does not equal no risk

Sample Why Not Now Questions Give me some reasons why you may want to live? You given me reasons why you want to die, can you tell me why you still want to live? Give me three reasons to keep on going?

Thank you!

NOPCAS,Inc P.O Washington, DC