1. Adolescent Suicide: Prevalence; Circumstance; and Conditions of Recognition Barri Sky Faucett, MA ASPEN Project Director

2. SUICIDE Intentional Self-Inflicted Death

3. Just the Facts Every 13.7 minutes another life is lost toEvery 13.7 minutes another life is lost to suicide, taking the lives of more than 38,364 suicide, taking the lives of more than 38,364 Americans every year. Americans every year. Every day 105.8 Americans take their own lifeEvery day 105.8 Americans take their own life Suicide is now the 10th leading cause ofSuicide is now the 10th leading cause of death in America; Homicide is 15 th. death in America; Homicide is 15 th. For young people 15-24 years old, suicideFor young people 15-24 years old, suicide is the third leading cause of death. is the third leading cause of death.

4. OUR Youth In 2010, there were 4,600 reported youth suicides in the United States. In 2010, there were 4,600 reported youth suicides in the United States. Each day there are approximately 12 youth suicides Each day there are approximately 12 youth suicides Most common method is firearms followed by suffocations Most common method is firearms followed by suffocations Males complete 4 times more than females; females attempt four times more than males. Males complete 4 times more than females; females attempt four times more than males.

5. 1 out of every 53 high school students (1.9 percent) reported having made a suicide attempt that was serious enough to be treated medically (CDC, 2010a). 1 out of every 53 high school students (1.9 percent) reported having made a suicide attempt that was serious enough to be treated medically (CDC, 2010a). Approximately 1 out of every 15 high school students attempts suicide each year (CDC, 2010a). Approximately 1 out of every 15 high school students attempts suicide each year (CDC, 2010a). For every completed suicide, there are 100-200 attempts among adolescents. For every completed suicide, there are 100-200 attempts among adolescents. Suicide Attempts

6. Suicide in Adolescents Research shows that most adolescent suicides occur after school hours and in the teens homes Research shows that most adolescent suicides occur after school hours and in the teens homes Most adolescent suicides are precipitated by interpersonal conflict Most adolescent suicides are precipitated by interpersonal conflict Within a typical high school classroom, it is likely that three students (one boy and two girls) have made a suicide attempt within the last year. Within a typical high school classroom, it is likely that three students (one boy and two girls) have made a suicide attempt within the last year. Suicide in Adolescents

7. Since GLS WV ranks 40 th in the nation with a rateSince GLS WV ranks 40 th in the nation with a rate of 8.9/100,000 vs. the national average of 10.5 (CDC 2010). How Does WV Compare?

8. WV Youth Suicide is the 2nd leading cause of death for WV Youth ages 15- 24! Suicide is the 2nd leading cause of death for WV Youth ages 15- 24!

9. Barbour Berkeley Boone Braxton Brooke Cabell Clay Fayette Gilmer Grant Greenbrier Hampshire Hancock Hardy Harrison Jackson Kanawha Lewis Lincoln Logan McDowell Marion Mason Mercer Mineral Mingo Monongalia Monroe Morgan Nicholas Ohio Pendleton Pocahontas Preston Putnam Raleigh Randolph Ritchie Roane Summers Taylor Tucker Tyler Upshur Wayne Webster Wetzel Wirt Wood Wyoming JeffersonPleasants Dodd- ridge Cal- houn 4 (12.26) 4 (12.56) 7 (10.81)) 12 (29.79) Marshall 10 (3.97) 5 (26.13) 4 (19.02) 2 (10.22) 3 (15.30) 4 (34.13)) 2 (12.97) 2 (16.07) 3 (20.28) 7 (20.00)) 2 (7.78) 3 (18.15) 11 (9.89) 2 (20.60) 3 (26.51) 18 (10.32) 4 (30.34) 47 (20.96)) 9 (20.92) 2 (6.79) 10 (10.55) 2 (13.69) 3 (8.81) 8 (20.23)) 6 (9.75) West Virginia Suicides by county Ages 15-24 2000-2009 Rate per 100,000 Population WV Average Rate 13.2/100,000 320 Deaths by Suicide 18.15 – 46.92 12.26 – 16.39 10.07 – 11.34 0.00 – 9.89 Suicide: A PREVENTABLE DEATH IN OUR STATE 5 (46.92) 12 (160.5) 4 (14.53) 2 (22.25) 2 (6.68) 1 (13.19) 5 (15.89) 6 (16.39) 1 (9.88) 3 (9.01) 1 (5.34) 0 (0.00) 16 (27.19) 13 (15.36) 1 (3.47) 3 (8.30) 3 (10.07) 4 (10.52) 10 (16.14) 11 (12.38) 0 (0.00) 1 (13.66) 10 (9.68) 5 (9.63) 0 (0.00) 2 (11.34)

10. Percentage of students who seriously considered attempting suicide during the 12 months before the survey. (9 th - 12 th ) YearUSWV 201115.813.0 Percentage of students who made a plan regarding how they would attempt suicide YearUSWV 201112.810.1 Percentage of students who attempted suicide one or more times during the 12 months before the survey. YearUSWV 20117.85.5 2011 West Virginia Youth Risk Behavior Survey

11. Identity Confusion Erickson Developmental Stage- Erickson Developmental Stage- Learning Identity Versus Identity Confusion (Fidelity) Learning Intimacy Versus Isolation (Love)

12. The Teenage Brain Adolescence is a time of profound brain growth. Adolescence is a time of profound brain growth. Greatest changes to the brain that are responsible for impulse control, decision making, planning, organization, and emotion occur in adolescence (prefrontal cortex). Greatest changes to the brain that are responsible for impulse control, decision making, planning, organization, and emotion occur in adolescence (prefrontal cortex). Do not reach full maturity until age 25. Do not reach full maturity until age 25.

13. What do teens deal with? Increased school pressures as they progress through higher grades Possibly first romantic relationships Exploring increased independence and identity Experimenting with substance use Puberty and Hormone fluctuation Bullying

14. Peer Problems Several studies have found relationships between suicidal behavior and social isolation, sexual orientation, and peer rejection. Several studies have found relationships between suicidal behavior and social isolation, sexual orientation, and peer rejection. 70% of suicide completions and attempts occur following the loss or conflict with family and peers. 70% of suicide completions and attempts occur following the loss or conflict with family and peers.

15. Lesbian, Gay, and Bisexual youth are 1 ½ - 7 times more likely to have reported ideation. Lesbian, Gay, and Bisexual youth are 1 ½ - 7 times more likely to have reported ideation. LGB Youth in multiple studies are found to be 3-4 times more likely to attempt suicide. LGB Youth in multiple studies are found to be 3-4 times more likely to attempt suicide. 58% of LGB youth who had attempted suicide reported they really hoped to die vs. 33% of heterosexuals who attempted and reported really hoping to die. 58% of LGB youth who had attempted suicide reported they really hoped to die vs. 33% of heterosexuals who attempted and reported really hoping to die. Have elevated risk factors and lower protective factors Have elevated risk factors and lower protective factors Sexual Identification

16. Bullying: 3 defining characteristics: 1. 1.Intentionalbehavior is deliberately harmful or threatening 2. Repeateda bully targets the same victim again and again 3.Power Imbalanceda bully chooses victims he or she perceives as vulnerable

17. YRBHS, 2011 (9 th -12 th ) Percentage of students who reported being bullied on school property YearUSWV 201120.118.6 Percentage of students who have ever been electronically bullied. YearUSWV 201116.215.5 Percentage of students felt sad or hopeless for greater than 2 weeks so that they stopped some general activities. YearUSWV 201128.524.5

18. Cyberspace CYBERSPACE is the new environment where " youth are forming communities.

19. Cyber bullying 93% of teens ages 12-17 are on the Internet. 75% of teens own a cell phone. A typical teen sends about >100 text messages a day. Most teen cell phone users make just 1-5 calls per day. 82% of online teens ages 14-17 are on social network sites

20. What makes Cyberbullying different? Distance Distance 24/7 24/7 Multiple methods Multiple methods Text messages; video clips; Websites; Social Media; IM; Emails; Chat rooms Anonymous Anonymous Expanded Audience Expanded Audience

21. Bullying effects Withdraws socially; has few or no friends. Withdraws socially; has few or no friends. Feels isolated, alone, and sad. Feels isolated, alone, and sad. Feels picked on or persecuted. Feels picked on or persecuted. Feels rejected and not liked. Feels rejected and not liked. Complains frequently of illness. Complains frequently of illness. Doesnt want to go to school; avoids some classes or skips school. Doesnt want to go to school; avoids some classes or skips school. Brings home damaged possessions or reports them lost. Brings home damaged possessions or reports them lost. Cries easily; displays mood swings and talks about hopelessness. Has poor social skills. Cries easily; displays mood swings and talks about hopelessness. Has poor social skills. Talks about running away/suicide. Talks about running away/suicide.

22. Bullying risks for suicide: Verbal Verbal Physical Physical Relational Relational Both victims and perpetrators of bullying are at a higher risk for suicide than their peers. Children who are both victims and perpetrators of bullying are at the highest risk One study found that victims of cyberbullying had higher levels of depression than victims of face-to-face bullying

23. Bullying and Suicide Billy Billy Phoebe Phoebe Hope Hope Megan Megan

24. SUICIDE: Myth or Fact Confronting a person about suicide will only make them angry and increase the risk of suicide. Confronting a person about suicide will only make them angry and increase the risk of suicide. Asking someone directly about suicidal intent lowers anxiety, opens up communication and lowers the risk of an impulsive actAsking someone directly about suicidal intent lowers anxiety, opens up communication and lowers the risk of an impulsive act

25. Myth or Fact Those who talk about suicide dont doThose who talk about suicide dont do it. it. People who talk about suicide mayPeople who talk about suicide may try, or even complete, an act of try, or even complete, an act of self-destruction. self-destruction.

26. Myth or Fact If a suicidal youth tells a friend, theIf a suicidal youth tells a friend, the friend will access help. friend will access help. Most young people do not tell anMost young people do not tell an adult adult

27. Risk Factors- characteristics that will may it more likely that an individual will consider, attempt, or die by suicide Warning Signs- behaviors that indicate signs of immediate risk Protective Factors- characteristics that make it less likely that individuals will consider, attempt, or die by suicide. SUICIDE- Risk Factors, Warning Signs, Protective Factors

28. Risk Factors- IS PATH WARM Ideation Ideation Substance Abuse Substance Abuse Purposelessness Purposelessness Anxiety Anxiety Trapped Trapped Hopelessness Hopelessness Withdrawal Withdrawal Anger Anger Recklessness Recklessness Mood Changes Mood Changes

29. Problems that increase Suicide Risk Prior suicide attempts Prior suicide attempts Mental health disorders Mental health disorders History of trauma or abuse History of trauma or abuse Family history of suicide Family history of suicide Lack of social support Lack of social support

30. Major physical illnesses Losses Bullying Easy access to lethal means Local clusters of suicide Situations that increase suicide risk

31. Firearms are used in 58% of successful suicides Firearms are used in 58% of successful suicides The rate of completed suicides is fives times higher in houses with firearms. The rate of completed suicides is fives times higher in houses with firearms. Firearms are even more prevalent in suicides involving alcohol. Firearms are even more prevalent in suicides involving alcohol. 65% of WV homes have firearms. 65% of WV homes have firearms. Access to means

32. Acquiring a gun or stockpiling pills Acquiring a gun or stockpiling pills Talking about wanting to die or kill oneself Talking about wanting to die or kill oneself Impulsivity/increased risk taking Impulsivity/increased risk taking Giving away prized possessions Giving away prized possessions Self-destructive acts (i.e., cutting) Self-destructive acts (i.e., cutting) Increased drug or alcohol abuse Increased drug or alcohol abuse Talking about no reason to live Talking about no reason to live Warning Signs:

33. Protective Factors Treatment for MH/SA, physical disorders Increased access to interventions Restricted access to highly lethal means Strong connections to family and community support Strong problem-solving and conflict resolution skills Cultural and religious beliefs that discourage suicide and support self-preservation.

34. Im tired of life, I just cant go on.Im tired of life, I just cant go on. My family would be better off without me. My family would be better off without me. Who cares if Im dead anyway. Who cares if Im dead anyway. I just want out. I just want out. I wont be around much longer. I wont be around much longer. Pretty soon you wont have to worry about me. Pretty soon you wont have to worry about me. Indirect or Coded Verbal Clues:

35. What to Do for the Individual Take it seriously Almost 80% of all suicides had given some warning of their intentions Ask Directly If you think that someone is suicidal, ask them about it

36. Tips for Asking the Question

37. What to do – Be Genuine Be Genuine Listen and dont show shock or disapprovalListen and dont show shock or disapproval Show that you care, it is more importantShow that you care, it is more important than saying the right thing. than saying the right thing. Avoid trying to explain away the feelings…(saying things like you have a lot to live for or you are just confused right now)Avoid trying to explain away the feelings…(saying things like you have a lot to live for or you are just confused right now)

38. What to Do Stay There Stay There Dont leave them alone. Dont leave them alone. Seek Help -Be actively involved in seeking professional help Seek Help -Be actively involved in seeking professional help

39. Plan for Safety KEEP SAFE Agreement KEEP SAFE Agreement Safety Contact (s) Safety Contact (s) Safe/no use of alcohol and drugs Safe/no use of alcohol and drugs Link to resources Link to resources Disable the suicide plan Disable the suicide plan Link to services Link to services Plan for Life Plan for Life

40. Potential Assessments Patient Health Questionnaire Modified for Teens (PHQ-9 Modified) Patient Health Questionnaire Modified for Teens (PHQ-9 Modified) 12-18 years of age 12-18 years of age Less than five minutes to complete and score Less than five minutes to complete and score Adolescent Suicide Assessment Protocol (ASAP-20) Adolescent Suicide Assessment Protocol (ASAP-20) Semi- structured clinical interview Semi- structured clinical interview Addresses 20 items associated with suicide risk Addresses 20 items associated with suicide risk

41. Offerings SOS Curriculums/ASPEN Workshop for Students SOS Curriculums/ASPEN Workshop for Students Evidence-Based Middle School and High School programs Evidence-Based Middle School and High School programs Brief Introductory Training Brief Introductory Training 25 minute Video 25 minute Video Guided Discussion Guided Discussion Screening Instrument Screening Instrument Jason Foundation Kits Jason Foundation Kits Orientation towards suicide prevention Orientation towards suicide prevention ASK CARE TELL cards for students ASK CARE TELL cards for students

42. ASPEN Offerings cont. ASPEN Presentation for your schools: ASPEN Presentation for your schools: Presentation- 35 minutes workshop for students Presentation- 35 minutes workshop for students Video Viewing- 13 minute movie regarding adolescent suicide Video Viewing- 13 minute movie regarding adolescent suicide Depression Screening- with active parental consent Depression Screening- with active parental consent ASAP-20 Follow-up for at-risk youth ASAP-20 Follow-up for at-risk youth Postvention services: Postvention services: Response support to school systems Response support to school systems Sudden Traumatic Loss Toolkit Sudden Traumatic Loss Toolkit

43. Trainings Awareness and QPR Awareness and QPR Adolescent Suicide Assessment Protocol Adolescent Suicide Assessment Protocol (ASAP-20) (ASAP-20) PCP Toolkit Training PCP Toolkit Training Implementation of Suicide Prevention Toolkit Implementation of Suicide Prevention Toolkit Applied Suicide Intervention Support Training (ASIST) Applied Suicide Intervention Support Training (ASIST)

44. www.suicidology.org www.sprc.org www.afsp.org www.spanusa.org www.wvaspen.com www.wvsuicidecouncil.org www.jasonfoundation.org www.jedfoundation.org For More Information

45. WV Contacts Bob Musick Executive Director WV Council for the Prevention of Suicide (304) 296-1731 bmusick@valleyhealthcare.org Barri Faucett, MA Project Director (304)-341-0511 ext 1691 (304)-341-0511 ext 1691 (304)-415-5787 (304)-415-5787barri.faucett@prestera.org