1. Mental Health EMERGENCIES

2. Mental Health: Emergencies This presentation deals with teen suicide, which is a most difficult topic to consider. This presentation deals with teen suicide, which is a most difficult topic to consider. It is presented upon recommendations from national public and private organizations because teen suicide is a significant health issue for both teens and families. It is presented upon recommendations from national public and private organizations because teen suicide is a significant health issue for both teens and families. It is based on current information from reliable sources, including: It is based on current information from reliable sources, including: –Mental Health Agencies –Centers for Disease Control and Prevention –American Association of Suicidology –Kids Peace –American Psychological Association

3. How Common Is Youth Suicide? In a typical high school classroom in any one school year… 5 students will have considered suicide. 5 students will have considered suicide. 2.5 students will make a non- fatal attempt. 2.5 students will make a non- fatal attempt. 1 student will make an attempt serious enough to require medical attention. 1 student will make an attempt serious enough to require medical attention. Source: DE MHA, 10 / 2005

4. How Common Is Youth Suicide? Suicide is the third leading cause of death among young people ages 15 to 24. Source: http://www.cdc.gov/ncipc/factsheets/suifacts.htm http://www.cdc.gov/ncipc/factsheets/suifacts.htm

5. How Common Is Youth Suicide? Boys are about four times more likely to commit suicide as are girls, while girls are twice as likely to attempt suicide. http://www.cdc.gov/ncipc/factsheets/suifacts.htm

6. Risk Factors in Youth Suicide 90 percent of children and adolescents who commit suicide have at least one mental disorder diagnosed before their death.

7. Risk Factors in Youth Suicide Risk factors are similar for boys and girls, but with marked differences in their relative importance: Among girls: Among girls: –The most significant risk factor is the presence of major depression, which increases the risk of suicide 12-fold. –The next most important risk factor is a previous suicide attempt, which increases the risk approximately threefold.

8. Risk Factors in Youth Suicide Risk factors are similar for boys and girls, but with marked differences in their relative importance: Among boys: Among boys: –A previous suicide attempt is the most potent predictor, increasing the rate over 30-fold. –The next most important risk factor is depression which increases the rate by about 12-fold. –Disruptive behavior increases the by twofold. –Substance abuse increases the risk by just under twofold.

9. Risk Factors in Youth Suicide Social-cultural risk factors: –Lack of social support and sense of isolation, –Stigma associated with help-seeking behavior, –Barriers to accessing health care, especially mental health and substance abuse treatment, –Certain cultural and religious beliefs (for instance, the belief that suicide is a noble resolution for a personal dilemma, –Exposure to others who have died by suicide, –Access to means of committing suicide (guns, pills…).

10. Risk Factors in Youth Suicide Bio-psychosocial risk factors: Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders, Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders, Alcohol and other substance use disorders, Alcohol and other substance use disorders, Hopelessness, Hopelessness, Isolation, Isolation, Impulsive and/ or aggressive tendencies, Impulsive and/ or aggressive tendencies, History of trauma or abuse, History of trauma or abuse, Previous suicide attempt, Previous suicide attempt, Family history of suicide. Family history of suicide.

11. Risk Factors in Youth Suicide Substance abuse as suicide risk Substance abuse as suicide risk –Alcohol and cocaine abuse are present in 2/3 of suicides among 18-19 year old males. –They are not commonly associated with female or younger male teen suicide. –Alcohol is a depressant and worsens depression.

12. Warning Signs The following signs could be an indication that someone is at risk for suicide. A sudden worsening in school performance, A sudden worsening in school performance, Self-mutilation, Self-mutilation, A fixation with death or violence, A fixation with death or violence, Unhealthy peer relationships, Unhealthy peer relationships, Volatile mood swings or a sudden change in personality. Volatile mood swings or a sudden change in personality.

13. Warning Signs Indications that the student is in an unhealthy, destructive, or abusive relationship, Indications that the student is in an unhealthy, destructive, or abusive relationship, Risk-taking behaviors, Risk-taking behaviors, Signs of an eating disorder, Signs of an eating disorder, Difficulty in adjusting to gender identity, Difficulty in adjusting to gender identity, Bullying, Bullying, Depression. Depression.

14. Precipitating Factors Most suicide attempts are precipitated by interpersonal conflicts and poor coping skills, including poor stress management. Source: American Association of Suicidology www.suicidology.org www.suicidology.org

15. Precipitating Factors Interpersonal conflicts often precede a suicide and/or suicide attempt. –Getting into trouble at school or with a law enforcement agency, –A ruptured relationship with a boyfriend or a girlfriend, –A fight among friends, –Family instability or conflict.

16. Precipitating Factors Stressful events often precede a suicide or suicide attempt. –Unplanned pregnancy, –An event related to sexual orientation. Source: Kids Peace The National Center for Kids Overcoming Crisis. www.kidspeace.org www.kidspeace.org

17. Precipitating Factors Suicide is often associated with poor coping skills to deal with a seemingly unbearable situation, such as: Grief or loss, Grief or loss, Acute or prolonged pain (emotional and physical), Acute or prolonged pain (emotional and physical), Desire to join a deceased loved one, Desire to join a deceased loved one, Means of self-punishment, Means of self-punishment, Anger at others, Anger at others, Act of defiance, punishment of survivors, or revenge, Act of defiance, punishment of survivors, or revenge, Aim to avoid punishment for a crime. Aim to avoid punishment for a crime.

18. Other Factors –Impulsive act during a psychotic episode, –Copycat intent – when there is a suicide in a large school, the chance of a second one increases by 300%.

19. When to Act to Prevent Suicide Some warning signs of suicide demand immediate action: –Talking or writing about suicide or death, –Giving direct verbal cues, such as "I wish I were dead" and "I'm going to end it all “, –Giving less direct verbal cues, such as "You will be better off without me," "What's the point of living?", "Soon you won't have to worry about me," and "Who cares if I'm dead, anyway?" –Expressing the belief that life is meaningless.

20. When to Act to Prevent Suicide Some warning behaviors of suicide demand immediate action: –Isolating him- or herself from friends and family, –Giving away prized possessions, –Exhibiting a sudden and unexplained improvement in mood after being depressed or withdrawn, –Neglecting appearance and hygiene, –Dropping out of school or social, athletic, and/or community activities, –Obtaining a weapon (such as a firearm) or another means of hurting him- or herself (such as prescription medications) ”.

21. How to Respond to Threats of Suicide How to Respond to Threats of Suicide ACT Acknowledge their distress. Acknowledge their distress. Care about them. Care about them. Tell someone who can help them. Tell someone who can help them. Source: find the source of the acronym ACT and credit its use

22. How to Respond to Threats of Suicide How to Respond to Threats of Suicide TAKE THEM SERIOUSLY. TAKE THEM SERIOUSLY. Call 911 if the threat is immediate. Call 911 if the threat is immediate. Call ANYWAY – even if they make you promise not to call. Call ANYWAY – even if they make you promise not to call. Find out where they are. Find out where they are. Remove any items with which the person may hurt themselves. Remove any items with which the person may hurt themselves.

23. Getting Help Only 20 percent to 40 percent of adolescents and children who attempt suicide receive follow-up care after receiving medical treatment in hospital emergency rooms – for the most part because parents and children fail to respond. http://www.apa.org/monitor/jun00/suicide.html

24. Barriers to Getting Help –Mental disorders are often denied by youth. –Those in need often refuse to seek help. –Those in need often believe nothing could help. –Those in need often do not know where to go. Source: DE MHA, 10 / 2005