1. STORM Skills-based training on risk management for suicide prevention Emma Campbell Primary Mental Health Worker Child and Adolescent Mental Health Services

2. Suicide Prevention Modules Problem Solving Crisis Management Assessment Crisis Prevention

3. Assessment Module 1

4. Exploring Suicidal Risk 1. Hopelessness It is the best single psychological predictor of suicide risk 2.Background knowledge Current problems and past attempts 3.Suicide intent The ‘Death’ question 4.Degree and seriousness of intent Specific plans for suicide 5.Risk Factors 6.Factors which make suicide more or less likely

5. Risk Factors Gender and ethnicity Social isolation:No friends No meaningful emotional support from family Role Change:No meaningful role in life: Unemployment Retirement No family role Recent separation / divorce / bereavement

6. Poor physical health: –Long-term, chronic illness –Especially if not treatment responsive History of violence towards others Homicidal thoughts: murder-suicides are not rare History of violent self-harm – e.g. attempted hanging Alcohol or drug problems Current mental illness

7. Factors which make Suicide more or less likely Risk is increased if there is… An immediate intention to carry out suicide A choice of violent method Current symptoms of mental illness Recurrent alcohol or drug problem/intoxication A past high risk attempt

8. The likelihood of further bad news - ‘the last straw’ A self-imposed deadline has passed Recent escalation of:Suicidal Behaviour Maladaptive Behaviour Help Seeking Behaviour Self Harming Behaviour HIGH suicide risk is indicated if there is increased frequency and/or seriousness of attempts

9. Risk is decreased if a person is… Looking forward to future events Suggesting that suicide is not intended if a particular event occurs - lowers immediate risk only Afraid of:Death Physical or mental damage inflicted if attempt fails Impact on family or friends No one to care for children and/or significant others No access to the means of suicide

10. The likelihood of further bad news - ‘the last straw’ A self-imposed deadline has passed Recent escalation of:Suicidal Behaviour Maladaptive Behaviour Help Seeking Behaviour Self Harming Behaviour HIGH suicide risk is indicated if there is increased frequency and/or seriousness of attempts

11. Summary You should ask about: Suicidal intent - thoughts of death Degree and seriousness - plan, means & measures to prevent detection Background - current problems Hopelessness, worthlessness & feelings of being trapped Symptoms of mental illness and/or signs of psychological distress, alcohol & drug use Past suicide attempt or self-harm Preparation for death – final acts, suicide note, Will Coping mechanisms - what stopped them from carrying it out so far?

12. Risk Assessment Guide Medium Suicide Risk Low Suicide Risk Medium - High Suicide Risk High Suicide Risk

13. Crisis Management Module 2

14. Ensuring Safety Ensure safety – identify means of lethality, check for other means – the A – test - what is acceptable and available. Appropriate support Family, friend and community support

15. Problem Solving Module 3

16. It is a popular self-help technique It is easily learned It is more effective as people generate their own solutions It has wide application for many psychiatric and psychological problems It can be used in addition to or instead of medication It is less stressful for professional carers Why Use Problem Solving?

17. Define Problem Option 2Option 1Option 3 ProsCons Rehearse Option & Worse Case Scenario Action Review Flow Diagram

18. Crisis Prevention Module 4

19. Techniques of Crisis Prevention Crisis prevention is a collaborative exercise with the client Ensure the immediate crisis has been diffused Have the difficulties been resolved? Are they likely to be repeated in the short/medium term? Explore physical signs, thoughts, feelings & triggers Explore exact circumstances which led up to the current crisis Explore self-help coping strategies and introduce new ones Build on what you know already from Assessment & Crisis Management Develop a crisis prevention plan