SAVING LIVES: Understanding Depression And Suicide In Our Communities

SAVING LIVES: Understanding Depression And Suicide In Our Communities
The Greene County Suicide Prevention Coalition Presented and Developed By Ellen Anderson, Ph.D., PCC,

Gatekeeper Training- Dr. Ellen Anderson
“Still the effort seems unhurried. Every 17 minutes in America, someone commits suicide. Where is the public concern and outrage?” Kay Redfield Jamison Author of Night Falls Fast: Understanding Suicide Gatekeeper Training- Dr. Ellen Anderson

Goals For Suicide Prevention
Increase community awareness that suicide is a preventable public health problem Increase awareness that depression is the primary cause of suicide Change public perception about the stigma of mental illness, especially about depression and suicide Increase the ability of the public to recognize and intervene when someone they know is suicidal In creating this training, goals were established in order to provide structure for the program. Goals for the training include: Participants can more readily identify people-at-risk They will be able to provide an appropriate initial response to people-at-risk They will know how to get them help And will consistently assist them in getting the appropriate help that they need Gatekeeper Training- Dr. Ellen Anderson

Prevention Strategies
Crisis Centers and hotlines Peer support programs Restriction of access to lethal means Intervention after a suicide General suicide and depression awareness education Depression Screening programs Community Gatekeeper Trainings In researching suicide prevention, several strategies were recommended. General Suicide Education: These programs provide people with facts about suicide, alert them to warning signs, and provide information about how to seek help for themselves or for others. Screening Programs: Screening programs assist in identifying high-risk persons in order to provide more targeted treatment. Community gatekeeper training: Like school gatekeeper training, this training provides information and resources to community members. Crisis Centers and hotlines: These programs provide telephone support and counseling for suicidal people. Peer Support Programs: These programs are designed to assist and support people and others at high-risk of suicide or suicidal behavior. Restriction of access to lethal means: Activities designed to restrict access to handguns, drugs, and other common means of suicide. Intervention after a suicide: Crisis response helps the community effectively cope with feelings of loss that come with the suicide of a friend or relative and prevent future suicides. Gatekeeper Training- Dr. Ellen Anderson

Suicide Is The Last Taboo – We Don’t Want To Talk About It
Suicide has become the Last Taboo – we can talk about AIDS, sex, incest, and other topics that used to be unapproachable. We are still afraid of the “S” word Understanding suicide helps communities become proactive rather than reactive to a suicide once it occurs Reducing stigma about suicide and its causes provides us with our best chance for saving lives Ignoring suicide means we are helpless to stop it Talking about suicide is scary. It’s hard to get people to come to trainings about suicide. In fact, many people ask the question, “Aren’t you opening a can of worms?” By making people more aware of and less afraid of suicide, we hope to assist communities to be proactive in preventing suicide, rather than reactive to a suicide that has occurred. Suicide is something that many think about at some point in life but no one wants to talk about. Pretending it doesn’t exist won’t make it go away. Not learning about suicide means we are helpless to stop it. In some churches, suicide is viewed as a failure of faith, a lack of trust in God, even a sin, not caring for the body and the life God has given us. Talking about suicide, its causes and associated feelings provides us with our best opportunity for prevention. Gatekeeper Training- Dr. Ellen Anderson

What Makes Me A Gatekeeper?
Gatekeepers are not mental health professionals or doctors Gatekeepers are responsible adults who spend time with people who might be vulnerable to depression and suicidal thoughts Teachers, coaches, police officers, EMT’s, Elder care workers, physicians, 4H leaders, Youth Group leaders, Scout masters, and members of the clergy and other religious leaders If you spend time with people who might be in a high risk group for suicidal behavior, you are a gatekeeper. Other gatekeepers include correctional facility staff, police officers, clergy, medical staff, elder-care workers, and emergency care workers. In reality, if you live in the world, you are a gatekeeper for friends, coworkers and family members as well. Gatekeeper Training- Dr. Ellen Anderson

Why Should I Learn About Suicide?
It is the 11th largest killer of Americans, and the 3rd largest killer of youth ages 10-24 Up to 25% of adolescents and 15% of adults consider suicide seriously at some point in their lives No one is safe from the risk of suicide – wealth, education, intact family, popularity cannot protect us from this risk A suicide attempt is a desperate cry for help to end excruciating, unending, overwhelming pain, 1996) People kill themselves for a lot of reasons, but the biggest one is the terrible, unending, unendurable pain sometimes called psychache. We tend to think that suicidal people are just “seeking attention” but the reality is they may be suffering terrible emotional pain. In fact, the so-called manipulative, attention-seeking folks are just as likely to die as those who are not. You see many people every day, and may be more likely than any other adult to hear and understand the kind of pain they are in. People are more likely to seek help from pastors, when they might never go to a therapist or tell their doctor of emotional pain. Gatekeeper Training- Dr. Ellen Anderson

What Is Mental Illness? Prior to our understanding of illness caused by bacteria, most people thought of any illness as a spiritual failure or demon possession Contamination meant spiritual contamination People were frightened to be near someone with odd behavior for fear of being contaminated Gatekeeper Training- Dr. Ellen Anderson

What Is Mental Illness? What do we say about someone who is odd? Looney, batty, nuts, crazy, wacko, lunatic, insane, fruitcake, psycho, not all there, bats in the belfry, gonzo, bonkers, wackadoo, whack job Why would anyone admit to having a mental illness? So much stigma makes it very difficult for people to seek help or even acknowledge a problem Gatekeeper Training- Dr. Ellen Anderson

What Is Mental Illness? We know that illnesses like epilepsy, Parkinson's and Alzheimer’s are physical illness in the brain Somehow, clinical depression, anxiety, Bi-Polar Disorder and Schizophrenia are not considered illnesses to be treated We confuse brain with mind Gatekeeper Training- Dr. Ellen Anderson

The Feel of Depression “I am 6 feet tall. The way I have felt these past few months, it is as though I am in a very small room, and the room is filled with water, up to about 5’ 10”, and my feet are glued to the floor, and its all I can do to breathe.” Gatekeeper Training- Dr. Ellen Anderson 11

Is Suicide Really a Problem?
83 people complete suicide every day 32,466 people in 2005 in the US Over 1,000,000 suicides worldwide (reported) This data refers to completed suicides that are documented by medical examiners – it is estimated that 2-3 times as many actually complete suicide (Surgeon General’s Report on Suicide, 1999) Many people do not think of suicide as a significant health issue in this country, but as you can see, we are losing many people to a completely treatable illness. If you think it is not important, consider that we lose 3 people to suicide for every 2 we lose to homicide, a statistic that has been stable for the past 100 years. Gatekeeper Training- Dr. Ellen Anderson

The Unnoticed Death For every 2 homicides, 3 people complete suicide yearly– data that has been constant for 100 years During the Viet Nam War from , we lost 55,000 troops, and 220,000 people to suicide Gatekeeper Training- Dr. Ellen Anderson

Comparative Rates Of U.S. Suicides-2005
Rates per 100,000 population National average per 100,000* White males African-American males ** Hispanic males Asians Caucasian females African American & Hispanic females Males over Annual Attempts – 810,000 (estimated) 150-1 completion for the young for the elderly (*AAS website),**(Significant increases have occurred among African Americans in the past 10 years - Toussaint, 2002) These figures, unfortunately, are merely an estimate. Some experts fear the numbers are at least 2-3 higher, since many suicides are not identified as such. Because the stigma is so high, and because there are real financial consequences to a suicidal death as well as social, deaths that cannot be definitively called suicide are usually called an accident. Cars driven into trees on a clear night with no alcohol involvement, for example. We want to protect other family members. People wonder if life insurance must pay on suicide, because in the past it did not. In most states, if the death occurs more than 2 years after the policy is in effect. Just an aside - suicide is no longer a crime, which is why we talk about completed rather than “committed” suicide. Gatekeeper Training- Dr. Ellen Anderson

The Gender Issue Women perceived as being at higher risk than men Women do make attempts 4 x as often as men But - Men complete suicide 4 x as often as women Women’s risk rises until midlife, then decreases Men’s risk, always higher than women’s, continues to rise until end of life Are women more likely to seek help? Talk about feelings? Have a safety network of friends? Do men suffer from depression silently? Gatekeeper Training- Dr. Ellen Anderson

What Factors Put Someone At Risk For Suicide?
Biological, physical, social, psychological or spiritual factors may increase risk-for example: A family history of suicide increases risk by 6 times Access to firearms – people who use firearms in their suicide attempt are more likely to die A significant loss by death, separation, divorce, moving, or breaking up with a boyfriend or girlfriend can be a trigger (Goleman, 1997) These are only a few of the factors, but are probably the most significant. Gatekeeper Training- Dr. Ellen Anderson

Social Isolation: people may be rejected or bullied because they are “weird”, because of sexual orientation, or because they are getting older and have lost their social network The 2nd biggest risk factor - having an alcohol or drug problem Many with alcohol and drug problems are clinically depressed, and are self-medicating for their pain (Surgeon General’s call to Action, 1999) People who are socially isolated tend to be very lonely. We know from other types of studies among primates, for example, that loneliness, literally, can kill you. We are a social animal, and we need contact with others. When we don’t get it, we become even more inappropriate in our behavior, more depressed, and less likely to see a reason for living. In some tribes, shunning, or ostracism, can lead to the death of the person who is shunned. They simply sit down, give up, and die. Gatekeeper Training- Dr. Ellen Anderson

The biggest risk factor for suicide completion? Having a Depressive Illness Someone with clinical depression often feels helpless to solve his or her problems, leading to hopelessness – a strong predictor of suicide risk At some point in this chronic illness, suicide seems like the only way out of the pain and suffering Many Mental health diagnoses have a component of depression: anxiety, PTSD, Bi-Polar, etc 90% of suicide completers have a depressive illness (Lester, 1998, Surgeon General, 1999) We really need to understand depression better, since it is the single biggest factor in suicide. Gatekeeper Training- Dr. Ellen Anderson

Depression Is An Illness
Suicide has been viewed for countless generations as: a moral failing, a spiritual weakness an inability to cope with life “the coward’s way out” A character flaw Our cultural view of suicide is wrong - invalidated by our current understanding of brain chemistry and it’s interaction with stress, trauma and genetics on mood and behavior Suicide’s direct link with depression is important to understand. What we have learned in the last 20 years is the way in which depression is a physical illness, one that can be cured with treatment. It is not a failure of faith, anymore than heart disease is a failure of faith. Gatekeeper Training- Dr. Ellen Anderson

The research evidence is overwhelming - depression is far more than a sad mood. It includes: Weight gain/loss Sleep problems Sense of tiredness, exhaustion Sad or angry mood Loss of interest in pleasurable things, lack of motivation Irritability Confusion, loss of concentration, poor memory Negative thinking Withdrawal from friends and family Usually, suicidal thoughts (DSMIVR, 2002) The DSM–IV, the diagnostic and statistical manual of mental health disorders, is quite clear on the group of symptoms that can be diagnosed as a depressive disorder. Although we do not have blood tests for this problem, the listed criteria can be easily determined, as long as the patient is telling the truth about their symptoms. Many come in with vague somatic complaints because, for many, the body literally aches. The surgeon general’s report says that an assessment of depressive symptoms is as accurate and reliable as many blood tests currently the standard for assessment. Gatekeeper Training- Dr. Ellen Anderson

20 years of brain research teaches that these symptoms are the behavioral result of Changes in the physical structure of the brain Damage to brain cells in the hippocampus, amygdala and limbic system As Diabetes is the result of low insulin production by the pancreas, depressed people suffer from a physical illness – what we might consider “faulty wiring” (Braun, 2000; Surgeon General’s Call To Action, 1999, Stoff & Mann, 1997, The Neurobiology of Suicide) Gatekeeper Training- Dr. Ellen Anderson

Faulty Wiring? Damage to nerve cells in our brains - the result of too many stress hormones – cortisol, adrenaline and testosterone – the hormones activated by our Autonomic Nervous System to protect us in times of danger Chronic stress causes changes in the functioning of the ANS, so that high levels of activation occur with very little stimulus Creates changes in muscle tension, imbalances in blood flow patterns leading to certain illnesses such as asthma, IBS and depression (Braun, 1999) As our brain cells become less able to connect with one another, our thinking changes in predictable ways. We find problem-solving more difficult, and get stuck on the idea that suicide is the only option. Most people tend to think of depression as affecting only the emotions, but it also hurts our thinking processes. For some time now we have wondered why increasing the amount of the neurotransmitter, serotonin, as most of the newer anti-depressants do, has slowly reduced the symptoms of depression. It seems clear now that increased serotonin blocks or reduces the effect of the stress hormones, allowing our nerve cells to begin functioning again. Gatekeeper Training- Dr. Ellen Anderson

Faulty Wiring? Without out a return to a baseline of rest, hormones accumulate, doing damage to brain cells People with genetic predispositions, placed in a highly stressful environment will experience damage to brain cells from stress hormones This leads to the cluster of thinking and emotional changes we call depression Stress alone is not the problem, but how we interpret the event, thought or feeling (Goleman, 1997; Braun, 1999) As our brain cells become less able to connect with one another, our thinking changes in predictable ways. We find problem-solving more difficult, and get stuck on the idea that suicide is the only option. Most people tend to think of depression as affecting only the emotions, but it also hurts our thinking processes. For some time now we have wondered why increasing the amount of the neurotransmitter, serotonin, as most of the newer anti-depressants do, has slowly reduced the symptoms of depression. It seems clear now that increased serotonin blocks or reduces the effect of the stress hormones, allowing our nerve cells to begin functioning again. Gatekeeper Training- Dr. Ellen Anderson

Where It Hits Us Gatekeeper Training- Dr. Ellen Anderson

One of Many Neurons Neurons make up the brain and their action is what causes us to think, feel, and act Neurons must connect to one another (through dendrites and axons) Stress hormones damage dendrites and axons, causing them to “shrink” away from other connectors As fewer and fewer connections are made, more and more symptoms of depression appear As dendritic branches die back, the result of onslaught by stress hormones, fewer and fewer connections can be made in these brain areas Gatekeeper Training- Dr. Ellen Anderson

As damage occurs, thinking changes in the predictable ways identified in our list of 10 criteria “Thought constriction” can lead to the idea that suicide is the only option How do antidepressants affect this “brain damage”? They may counter the effects of stress hormones We know now that antidepressants stimulate genes within the neurons (turn on growth genes) which encourage the growth of new dendrites (Braun, 1999) Gatekeeper Training- Dr. Ellen Anderson

Renewed dendrites increase the number of neuronal connections The more connections, the more information flow, the more flexibility the brain will have Why does increasing the amount of serotonin, as many anti-depressants do, take so long to reduce the symptoms of depression? It takes 4-6 weeks to re-grow dendrites & axons (Braun, 1999) Gatekeeper Training- Dr. Ellen Anderson

How Does Psychotherapy Help?
Medications may improve brain function, but do not change how we interpret stress Psychotherapy, especially cognitive or interpersonal therapy, helps people change the (negative) patterns of thinking that lead to depressed and suicidal thoughts Research shows that cognitive psychotherapy is as effective as medication in reducing depression and suicidal thinking Changing our beliefs and thought patterns alters our response to stress – we are not as reactive or as affected by stress at the physical level (Lester, 2004) Gatekeeper Training- Dr. Ellen Anderson

What Therapy? The standard of care is medication and psychotherapy combined At this point, only cognitive behavioral and interpersonal psychotherapies are considered to be effective with clinical depression (evidence-based) Patients should ask their doctor for a referral to a cognitive or interpersonal therapist Gatekeeper Training- Dr. Ellen Anderson

Possible Sources Of Depression
Genetic: a predisposition to this problem may be present, and depressive diseases run in families Predisposing factors: Childhood traumas, car accidents, brain injuries, abuse and domestic violence, poor parenting, growing up in an alcoholic home, chemotherapy Immediate triggers: violent attack, illness, sudden loss or grief, loss of a relationship, any severe shock to the system (Anderson, 1999, Berman & Jobes, 1994, Lester, 1998) We do not yet know how genetic factors predispose people to depressive illnesses, but research suggests that heredity is definitely a factor Predisposing factors are varied, but most seem to be the result of extreme stress, either acute, as in an illness, or chronic, as in domestic violence, sexual abuse of children, or poor parenting. Stress seems to have a powerful impact on the amygdala, the place in our brain where we respond to stress or danger. It also increases the agitation of the limbic system, and seems to damage cells in the hippocampus. Severe shocks to the system may or may not lead to depression, but predisposing factors and heredity, teamed with a severe shock, will almost certainly lead to depression Gatekeeper Training- Dr. Ellen Anderson

What Happens If We Don’t Treat Depression?
Significant risk of increased alcohol and drug use Significant relationship problems Lost work days, lost productivity (up to $40 billion a year) High risk for suicidal thoughts, attempts, and possibly death (Surgeon General’s Call To Action, 1999) We know the damage alcohol and drug abuse cause our families, our bodies, and our relationships with others When one spouse is clinically depressed, the other may not recognize it for what it is, and become angry with the loss of companionship, irritability, lack of responsibility, and other symptoms that seem inexplicable when we don’t understand what depression really is. When children become irritable, mouthy, begin failing in school, and showing other signs of depression we may read it as anti-social behavior, rebellion, or inexplicable anger – normal children do not avoid parents and friends, spend all their days angry, and sleep non-stop. Considering what we have learned, it seems criminal to ignore the need for treatment of depression in our society. It’s as if we had chosen to ignore lung cancer Gatekeeper Training- Dr. Ellen Anderson

Depression is a medical illness that will likely affect the person later in life, even after the initial episode improves Youth who experience a major depressive episode have a 70% chance of having a second major depressive episode within five years Many of the same problems that occurred with the first episode are likely to return, and may worsen (Oregon SHDP) We tend to resist diagnosing depression in youth, thinking of it as “growing pains”, rebellion, or developing a bad set of friends, but many adolescents experience significant clinical depression – as many as 25% of our youth. Gatekeeper Training- Dr. Ellen Anderson

Suicide Myths – What Is True?
1.Talking about suicide might cause a person to act False – it is helpful to show the person you take them seriously and you care. Most feel relieved at the chance to talk 2. A person who threatens suicide won’t really follow through False – 80% of suicide completers talk about it before they actually follow through 3. Only “crazy” people kill themselves False - Crazy is a cruel and meaningless word. Few who kill themselves have lost touch with reality – they feel hopeless and in terrible pain (AFSP website, 2003) 1. If you ask a person about suicide and they are not thinking about it, they will tell you so and go on – if they are already thinking of it, you now have a chance to talk with them and reduce their sense of hopelessness, reducing the likelihood that they will attempt it. If you will not talk with them, what will intervene in their despair? If no one notices, no one talks to them, will they not believe things really are hopeless? Because depression tends to be a chronic illness, people may fight suicidal thoughts for years, and may talk about it often before attempting. 2. The word crazy should be dropped from our vocabulary. It has become so demeaning and cruel, especially when people are suffering from an illness, and only serves to stigmatize and reduce the chance that people will take the illness seriously. If someone is crazy, we don’t have to have compassion for them, don’t have to seek a cure, don’t have to treat them as human. Gatekeeper Training- Dr. Ellen Anderson

4. No one I know would do that False - suicide is an equal opportunity killer – rich, poor, successful, unsuccessful, beautiful, ugly, young, old, popular and unpopular people all complete suicide 5. They’re just trying to get attention False – They are trying to get help. We should recognize that need and respond to it Suicide is a city problem, not a rural problem False – rural areas have higher suicide rates than urban areas 1.Depression knows no boundaries and can affect anyone, even people who seem to have everything 2.We often struggle with parents who tell us their kid is just “seeking attention”. If someone were struggling with a physical ailment and kept asking for help for the pain, we would react appropriately and help them relieve the pain. When the pain is emotional, we need to react in the same way. 3. This is true throughout Ohio. Wyandot county with a population of 35,000, has one of the highest suicide rates in the state. Gatekeeper Training- Dr. Ellen Anderson

Suicide myths, continued: Once a person decides to die nothing can stop them - They really want to die NO - most people want to be stopped – if we don’t try to stop them they will certainly die - people want to end their pain, not their lives, but they no longer have hope that anyone will listen, that they can be helped (AFSP website, 2003) . Gatekeeper Training- Dr. Ellen Anderson

How Do I Know If Someone Is Suicidal?
Now we understand the connection between depression and suicide We have reviewed what a depressed person looks like Not all depressed people are actively suicidal – how can we tell? Suicides don’t happen without warning - verbal and behavioral clues are present, but we may not notice them This first should seem obvious, and is the most highly correlated to actual completion, but many dismiss it as attention seeking behavior. Yet most who complete suicide have made one or more attempts in their past. We need to think of this as a first step that may lead to more attempts. Some disagree that suicides don’t happen without warning, and maybe there are a few – but if we look at the symptom list, and the behaviors we have seen before the suicide, it may become apparent that we did not know what we were seeing. Gatekeeper Training- Dr. Ellen Anderson

Verbal Expressions Common statements I shouldn't be here I'm going to run away I wish I could disappear forever If a person did this or that., would he/she die Maybe if I died, people would love me more I want to see what it feels like to die I wish I were dead I'm going to kill myself Sometimes red flags come in the form of what people say. It is not always the words, sometimes it is the tone of voice – flat, “dead”, muted speaking. Sometimes statements are direct and to the point, such as: “I wish I were dead.” “I am going to kill myself.” “I’m going to end it all.” “I don’t want to live anymore.” Indirect statements can be more subtle. These may include such things as: “No one cares if I live or die.” “Does it hurt to die?” “You’d be better off without me.” “They’ll be sorry when I am gone.” These comments should not be ignored, or considered attention seeking. These are clear indicators that someone no longer believes life is worth living. This is not a temporary funk, but a serious medical condition which may lead to death. People who talk about killing themselves are preparing themselves, and everyone else, for the actual act. Gatekeeper Training- Dr. Ellen Anderson

Some Behavioral Warning Signs
Common signs Previous suicidal thoughts or attempts Expressing feelings of hopelessness or guilt (Increased) substance abuse Becoming less responsible and motivated Talking or joking about suicide Giving away possessions Having several accidents resulting in injury; "close calls" or "brushes with death" Gatekeeper Training- Dr. Ellen Anderson

Further Behaviors Often Seen in Kids
Preoccupation with death/violence; TV, movies, drawings, books, at play, music Risky behavior; jumping from high places, running into traffic, self-cutting School problems – a big drop in grades, falling asleep in class, emotional outbursts or other behavior unusual for this student Wants to join a person in heaven Themes of death in artwork, poetry, etc Gatekeeper Training- Dr. Ellen Anderson

What On Earth Can I Do? Anyone can learn to ask the right questions to help a depressed and suicidal person Depression is an illness, like heart disease, and suicidal thoughts are a crisis in that illness, like a heart attack You would not leave a heart attack victim lying on the sidewalk – many have been trained in CPR We must learn to help people who are dying more slowly of depression Many people feel that talking to someone about suicide is just too hard.. The “S” question is one that many clinicians have trouble asking, because to get a yes answer gives us a tremendous responsibility. We don’t have to ask a heart attack victim if they are dying – we can see it, yet we would not hesitate to help. Nor would we take the blame if, having tried CPR, a heart attack victim died anyway. We are fearful of the awesome responsibility of keeping a suicidal, depressed person alive. If not us, who? Yes, we are our brother/sister’s keeper. And yes, we can learn to ask. And, we have the opportunity to help people understand that depression and suicidal thoughts are an illness, not a problem or character flaw We learned to do CPR by the millions, and we can learn to ask the S questions, too. Gatekeeper Training- Dr. Ellen Anderson

What Stops Us? Most of us still believe suicide and depression are “none of our business” and are fearful of getting a yes answer What if : we could respond to “yes”? We could recognize depression symptoms like we recognize symptoms of a heart attack? We were no longer afraid to ask for help for ourselves, our parents, our children? We no longer had to feel ashamed of our feelings of despair and hopelessness, but recognized them as symptoms of a brain disorder? Gatekeeper Training- Dr. Ellen Anderson

Reduce Stigma Stigma about having mental health problems keeps people from seeking help or even acknowledging their problem Reducing the fear and shame we carry about having such “shameful” problems is critical People must learn that depression is truly a disorder that can be treated – not something to be ashamed of, not a weakness Learning about suicide makes it possible for us to overcome our fears about asking the “S” question Gatekeeper Training- Dr. Ellen Anderson

Learning “QPR” – Or, How To Ask The “S” Question
It is essential, if we are to reduce the number of suicide deaths in our country, that community members/gatekeepers learn “QPR” First designed by Dr. Paul Quinnett as an analogue to CPR, “QPR” consists of Question – asking the “S” question Persuade– getting the person to talk, and to seek help Refer – getting the person to professional help (Quinnett, 2000) 40 years ago someone thought it would be a good idea if the average American could learn some basics that would keep a person who was having a heart attack alive until the ambulance arrived. Millions of us have learned CPR, and many have been saved who might otherwise have died. Now we need to learn how to do it again, all of us, to stop the unnecessary deaths caused by depression and mental illness. Both on and off the job, if we all learned QPR, we could save a lot of lives. Gatekeeper Training- Dr. Ellen Anderson

Ask Questions! You seem pretty down Do things seem hopeless to you Have you ever thought it would be easier to be dead? Have you considered suicide? Remember, you cannot make someone suicidal by talking about it. If they are already thinking of it they will probably be relieved that the secret is out If you get a yes answer, don’t panic-ask a few more questions Whether you are involved with a person in a home, at your church/temple/mosque, at a nursing home or another setting, learn to ask questions when you see signs of depression and suicidal thinking, as discussed before. If they are not thinking about it, they will simply tell you so. Gatekeeper Training- Dr. Ellen Anderson

How Much Risk Is There? Assess lethality You are not a doctor, but you need to know how imminent the danger is Has he or she made any previous suicide attempts? Does he or she have a plan? How specific is the plan? Do they have access to means? This can be done by asking a series of questions: One sign is seldom enough to predict suicidal thoughts. Look for many of the previously mentioned signs – giving things away, sadness, etc. Has the person made previous attempts? This is one of the biggest risk factors Does the individual have a plan? If there is a plan, there is an increased risk of suicidal behavior Does the individual have access to means that would assist in carrying out the plan? Having the means to carry out the plan further increases risk, and signifies that action should be taken immediately to ensure the safety of the individual. Gatekeeper Training- Dr. Ellen Anderson

Do . . . Use warning signs to get help early Talk openly- reassure them that they can be helped - try to instill hope Encourage expression of feelings Listen without passing judgment Make empathic statements Stay calm, relaxed, rational The best way to get them to open up to you is to ask specific questions and to listen without passing judgment. People are already ashamed of their suicidal thoughts, and if they experience judgment from you, they are likely to stop talking. If you can’t think of anything to say, simply invite more information by saying, “Tell me more about that.” Empathic statements can be as simple as “I can see how you might feel that way”, “it must have been hard for you” Your calmness is crucial. Suicidal people are in a crisis, and see no hope. If you get upset and anxious, this will confirm their fears. If you can stay calm and rational, they will de-escalate also, and begin to see there might be help if they tell someone what they are feeling. Gatekeeper Training- Dr. Ellen Anderson

Don’t… Make moral judgments Argue lecture, or encourage guilt Promise total confidentiality/offer reassurances that may not be true Offer empty reassurances – “you’ll get over this” Minimize the problem -“All you need is a good night’s sleep” Dare or use reverse psychology - “You won’t really do it” - - “Go ahead and kill yourself” Leave the person alone Make moral judgments – no arguing or lecturing Act shocked rather, handle the situation calmly, they will be encouraged to talk if you are calm Encourage guilt (e.g. your children will be sad, and you don’t want them to have to grieve over your death) This is also not helpful, and not what the individual needs. Promise total confidentiality/offer reassurances that may not be true For most professionals confidentiality is required to be broken when individuals state their intentions to harm themselves or others. Even if you do not have this requirement as part of your profession, suicide should never be kept a secret. Offer empty reassurance – a person in terrible pain cannot hear that others are worse off – this may actually may make them feel more guilty (I can’t even do this right!) Minimize the problem/offer simplistic solutions If they believed a simple solution would work they would not be suicidal. This assumes they haven’t really thought about things, which is seldom true. Most helpful is validating the problem with empathetic listening (I.e. do your best to understand the problem from “their perspective”, and show them you understand. Dare the person (e.g.“You won’t really do it.”) This may expedite suicidal behavior and/or be the deciding factor for those individuals who are teetering. Use reverse psychology (e.g. “Go ahead and kill yourself.”) This sometimes works with different situations, but is not worth the risk when the consequences are life and death. Leave the person alone This is critical, especially if your risk assessment has lead to a high probability of completion. Gatekeeper Training- Dr. Ellen Anderson

Never Go It Alone! Collaborate with others The person him/herself Family and friends School personnel or co-workers Emergency room Police/sheriff Family doctor Crisis hotline Community agencies Others with whom to collaborate may seem obvious, but here they are: This is not an exhaustive list, but the main point is that you don’t have to go it alone! Gatekeeper Training- Dr. Ellen Anderson

Getting Help Refer for professional help When people exhibit 5 or more symptoms of depression When risk is present (e.g. Specific plan, available means) Learn your community resources – know how to get help At what point should you make a referral for professional help? Signs of depression may indicate the person is at risk for suicidal ideation. Depression is a very treatable illness, and no one should have to suffer with untreated depression. When risk is present (e.g. specific plan, available means) Err on the side of over-referral, remember the consequences here are high stakes! Know your community resources Educate yourself on these, or at a minimum be aware of someone who does have these resources Gatekeeper Training- Dr. Ellen Anderson

Local Professional Resources
Your Hospital Emergency Room Your Local Mental Health Agencies Your Local Mental Health Board School Guidance Counselors Local Crisis Hotlines National Crisis Hotlines Your family physician School nurses 911 Local Police/Sheriff Local Clergy There are many resources available to assist people, their families and those working closely with them. Learn the ones in your community. Gatekeeper Training- Dr. Ellen Anderson

Survivors Of Suicide Sources of support for families of suicide completers are almost non-existent, unless a survivors of suicide group is available If you know people who have experienced this tragedy, talk with them about it Explain what you know about depression - help them understand they are not at fault, that their loved one was ill Help them understand the unendurable psychache their loved one experienced –it may help them resolve some of their anger Consider helping to start an SOS group in your community – many survivors have found these groups to be invaluable in helping them deal with the loss of a family member to suicide. Gatekeeper Training- Dr. Ellen Anderson

Final Suggestions You may know many people with depression Are they comfortable telling you about this vulnerable place in their life? Openness and discussion about depression and suicidal thinking can free people to talk Help spread the word in your church, PTA group, sports team, circle of friends Help people emerge from the stigma our culture has placed on this and other mental health problems Become aware of your own vulnerability to depression (Anderson, 1999) Making depression a comfortable topic for your congregation can really help move our culture toward a better understanding about this deadly disorder. Remember how Betty Ford opened us up to discussions about Breast Cancer and Addiction? The more we are open to understanding, the more we will be able to change people’s attitudes, which will make them more likely to seek help without feeling stigmatized. Gatekeeper Training- Dr. Ellen Anderson

Permanent Solution- Temporary Problem
Remember a depressed person is physically ill, and cannot think clearly about the morality of suicide, cannot think logically about their value to friends and family You would try CPR if you saw a heart attack victim Don’t be afraid to “interfere” when someone is dying more slowly of depression Depression is a treatable disorder Suicide is a preventable death This well-known quote, from Dr. Edwin Schneidman, the founder of suicidology, is a key idea that helps us stay focused on our goal. WE need to help people understand there are other solutions available, no matter how difficult the problem may be. Gatekeeper Training- Dr. Ellen Anderson

The Ohio Suicide Prevention Foundation
The Ohio State University, Center on Education and Training for Employment 1900 Kenny Road, Room 2072 Columbus, OH 43210 Gatekeeper Training- Dr. Ellen Anderson

Websites For Additional Information
Ohio Department of Mental health NAMI Suicide Prevention Resource Center American association of suicidology Suicide awareness/voice of education American foundation for suicide prevention Suicide prevention advocacy network QPR institute Gatekeeper Training- Dr. Ellen Anderson

A Brief Bibliography Anderson, E. “The Personal and Professional Impact of Client Suicide on Mental Health Professionals. Unpublished Doctoral dissertation, U. of Toledo, 1999. Beck, A.T., Steer, R.A., Kovacs, M., & Garrison, B. (1985). Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide and Life-Threatening Behavior. 23(2), Berman, A. L. & Jobes, D. A. (1996) adolescent suicide: assessment and intervention. Blumenthal, S.J. & Kupfer, D.J. (Eds.) (1990). Suicide Over the Life Cycle: Risk Factors, Assessment, and Treatment of Suicidal Patients. American Psychiatric Press. Braun, S. (2000). Unlocking the Mysteries of Mood: The Science of Happiness. Wiley and Sons, NY. Calhoun, L.G, Abernathy, C.B., & Selby, J.W. (1986). The rules of bereavement: Are suicidal deaths different? Journal of Community Psychology, 14, Gatekeeper Training- Dr. Ellen Anderson

Doka, K.J. (1989). Disenfranchised Grief: Recognizing hidden sorrow. Lexington, MA: Lexington Books. Dunne, E.J., MacIntosh, J.L., & Dunne-Maxim, K. (Eds.). (1987). Suicide and its aftermath. New York: W.W. Norton. Empfield, M & Bakalar, N. (2001) Understanding Teenage Depression: A guide to Diagnosis, Treatment and Management. Holt & Co., NY. Jacobs, D., Ed. (1999). The Harvard Medical School Guide to Suicide Assessment and Interventions. Jossey-Bass. Jamison, K.R., (1999). Night Falls Fast: Understanding Suicide. Alfred Knopf . Krysinski, P.K. (1993). Coping with suicide: Beyond the three day bereavement leave policy. Death Studies: 17, Lester, D. (1998). Making Sense of Suicide: An In-Depth Look at Why People Kill Themselves. American Psychiatric Press. Gatekeeper Training- Dr. Ellen Anderson

Oregon Health Department, Prevention. Notes on Depression and Suicide: ttp:// President’s New Freedom Council on Mental Health, 2003. Rosenblatt, P. (1996). Grief that does not end. In D. Klass, P. Silverman, & S. Nickman (Eds.), Continuing Bonds: New Understandings of grief (pp 45-58). Washington, D.C.: Taylor & Francis. Rowling, L. (1995). The disenfranchised grief of teachers. Omega, 31(4), Smith, Range & Ulner. “Belief in Afterlife as a buffer in suicide and other bereavement.” Omega Journal of Death and Dying, , (24)3; Gatekeeper Training- Dr. Ellen Anderson

Stoff, D.M. & Mann, J.J. (Eds.), (1997). The Neurobiology of Suicide. American Academy of Science Quinnett, P.G. (2000). Counseling Suicidal People. QPR Institute, Spokane, WA Sheskin, A., & Wallace, S.E. (1976). Differing bereavements: Suicide, natural, and accidental deaths. Omega 7, Shneidman, E.S.(1996).The Suicidal Mind. Oxford University Press. Styron, W. (1992). Darkness Visible. Vintage Books Surgeon General’s Call to Action (1999). Department of Health and Human Services, U.S. Public Health Service. Thompson, K. & Range, L. (1992). Bereavement following suicide and other deaths: Why support attempts fail. Omega 26(1), Valent, P. (1995). Survival strategies: A framework for understanding Secondary Traumatic Stress and coping in helpers. In C. Figley (Ed.) Compassion Fatigue (pp21-50). New York: Brunner Mazel. Gatekeeper Training- Dr. Ellen Anderson

SAVING LIVES: Understanding Depression And Suicide In Our Communities

Similar presentations

Presentation on theme: "SAVING LIVES: Understanding Depression And Suicide In Our Communities"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

SAVING LIVES: Understanding Depression And Suicide In Our Communities

Similar presentations

Presentation on theme: "SAVING LIVES: Understanding Depression And Suicide In Our Communities"— Presentation transcript:

Similar presentations

About project

Feedback