Mental Health Emergencies

1. Teen Suicide Mental HealthEmergencies

2. Mental Health: Emergencies • 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 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 atypical high school classroom in any one school year… • 5 students will have considered suicide. • 2.5students will make a non-fatal attempt. • 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. The number has tripled in recent years. Source: http://www.cdc.gov/ncipc/factsheets/suifacts.htm

5. Facts on Teen Suicide • Teenage suicide is preventable • When a person is depressed, they are NOT thinking, feeling, or acting the way they normally do • We must learn what the warning signs are and who is at higher risk • Every day in the U.S., approximately 14 young people between the ages of 15-24 die at their own hands • That's one suicide every 1 hour and 40 minutes

6. Myths of Suicide • Teenagers who talk about attempting suicide are doing it for attention. • True, and they NEED the attention. There is something going on that's causing them to feel this way. They need people to listen, and professionals to help them. • All teenagers who are suicidal are depressed. • This statement is true, but the reverse is not true, most people will experience times in their lives when they are depressed, but have no suicidal ideation. • Suicidal people really want to die, so there's no way to stop them. • False. They are depressed and need help. With help, they can feel better and find other solutions. • Talking about suicide will cause a student to attempt suicide. • False. It's just the opposite: not talking about it could escalate the problem. Even thinking about it makes the suicidal person feel worse.

7. Myths of Suicide • If a person really wants to kill himself or herself, no one has the right to stop him or her. • False. We would help a person who was physically sick or injured; we need to help a person who is mentally ill. • Once a person is suicidal, they're suicidal forever. • False. Teens who are suicidal can go on to lead useful lives, once they get help. Usually the suicidal feelings are for a limited period of time. • Improvement following a suicidal crisis means that the suicide risk is over. • False. Most suicides occur within 3 months following the beginning of "improvement", when the teen has the energy to put their morbid thoughts and feelings into effect. Relatives and physicians should be especially vigilant during this period.

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

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

10. Risk Factors in Youth Suicide Risk factors are similar for boys and girls, but with marked differences in their relative importance: • 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.

11. Risk Factors in Youth Suicide Risk factors are similar for boys and girls, but with marked differences in their relative importance: • 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.

12. 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…).

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

14. Risk Factors in Youth Suicide • 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.

15. Risk Factors in Youth Suicide – High Risk Students • Teenagers who have attempted suicide previously • Teenagers with little self-esteem • Teenagers in trouble with the law • Teenagers who are suffering from depression • Teenagers who have been abused, molested, or neglected • Teenagers who abuse drugs and/or alcohol • Teenagers who are perfectionists • Teenagers who are struggling with sexual orientation (gays and lesbians) • Teenagers who are in dysfunctional families • Teenagers who fail in school-potential dropouts

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

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

18. Warning Signs • A recent suicide in the family or friend • Trouble coping with recent losses, death, divorce, moving, break-ups, etc. • Experience with a traumatic event • Making final arrangements, such as writing a will or eulogy, or taking care of details • Gathering of lethal weapons (purchasing weapons, collecting pills, etc.). • Giving away prized possessions such as clothes, CD's, sports equipment, treasured jewelry, etc.

19. Verbal Signs • "I can't go on anymore" • "I wish I was never born" • "I wish I were dead" • "I won't need this anymore" • "My parents won't have to worry about me anymore" • "Everyone would be better off if I was dead" • "Life sucks. Nobody cares if I live or die"

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

21. 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.

22. 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

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

24. 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%.

25. 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.

26. 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)”.

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

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

29. 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

30. 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