Suicide and Crisis

1. Suicide and Crisis Beverly Wohlert Practicum I April 4, 2011

2. WHY? Suicide may be response to extreme emotional pain, various brain chemistry deficiencies and/or disorders, prolonged life circumstances of extreme stress, an emotional upset, abuse, poverty, terrible living conditions, neglect, poor health, injury, disability- When there is SADNESS or the person is HOPELESS Suicidal thoughts are involuntary.

3. Suicide • I. Who attempts or completes suicide • 2. Common mental health issues associated with suicide, including non suicidal self injury (DTS) • 3. Danger to others (DTO) 4 .Substance Abuse, Domestic Violence and Rape 5. What to do? • 6. Resources • 7. Practice

4. Who? • Faces of Suicide: • http://www.youtube.com/watch?v=whOerPSYvQc&feature=related

5. True of False? • 1. Asking about suicide will put the idea in the person’s mind? • 2. Someone who talks about suicide is not really serious?

6. According to the Center for Disease Control (CDC) there were 34, 598 deaths in 2009 from suicide (2010). Everyone is at risk, however there is an increases risk for: Males vs. Females Age Chronic physical illness Mental illness Substance Abuse Lack of social supports Family history Previous suicide or self-harm attempts A person with an organized plan http://www.youtube.com/watch?v=OhCH9mt0Pow&feature=fvwrel

7. Mental Health • Depression; (P&PPD) • Anxiety • Bipolar Disorder • Borderline Personality Disorder* • PTSD* • ******Not everyone who suffers from depression or mental illness will be suicidal******

8. Mental Health • Depression: Feeling sad, blue, unhappy, miserable, or down in the dumps. This is a common feeling for most people at one time or another, but usually for short-periods of time. Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life or for a long period of time (PUB MED, 2010) • Anxiety: A state of apprehension, uncertainty, and fear resulting from the anticipation of a realistic or fantasized threatening event or situation, often impairing physical and psychological (NIMH, 2010). • Bipolar disorder and Schizophrenia

9. Borderline Personality Disorder Borderline personality disorder is a condition in which people have long-term patterns of unstable or turbulent emotions, such as feelings about themselves and others. These inner experiences often cause them to take impulsive actions and have chaotic relationships (NIMH, 2009).

11. NSSI (Non suicidal self injury) • http://www.youtube.com/watch?v=Qt9SOvILMI8 • On average there are 400,000 people in the U.S. that visit the ER for non suicidal self-injury (www.suicide.org, 2001). • Reasons: Escape unbearable pain, change the behavior of others, “get back at” other people, gain relief from tension, to seek help • http://www.youtube.com/watch?v=P0FW12WzG1o&feature=related

12. ALGEE • **This is if the person is NOT IN AN IMMEDIATE CRISIS** • Assess for risk of suicide or harm • Listen non-judgementally • Give reassurance and information • Encourage appropriate professional help • Encourage self-help and other support strategies (Exercise, peer support groups, relaxation and meditation, faith and other social networks, self-help books based on CBT)

13. How to Help with NSSI • DO: • Let the person know that you notice the injuries and are concerned and willing to help. • Recognize that self-injury is usually a symptom of serious psychological distress. • Let the person know that treatment is available for this distress • Ensure that the person knows where to access professional and crisis help and they they have clear contact information available • Encourage but DO NOT force the person to seek treatment

14. Mental Health continued • BPD vs. Anti-social personality disorder ASPD- Personality disorder that involves disregard for the rights or others, as well as impulsive, irresponsible and aggressive behavior (DSM IV) • Mania- Increased energy and over activity, elate mood, need for less sleep, irritable, rapid thoughts and speech, grandiose delusions, lack of insight, increased spending • Psychosis- Usually occurs in an episode and is not a constant condition. A person may have severe disturbances in thinking, emotion, and behavior. This maybe a change in emotion or motivation to include depression anxiety, irritability ,suspiciousness, flat affect or inappropriate emotion, change in appetite, sleep, and / or concentration. A person may have an increase or reduction of senses, and or feelings that others have changed or acting differently. This can be “drug induced.”

15. ALGEE (cont.) • Assess for risk of suicide or harm by directly and confidently asking: • SLAP or DIRT • Are you thinking about harming yourself? Do you have thoughts of suicide? Are you considering taking your own life? Are you feeling like you might want die? Are you feeling unsafe (NSSI)? • How are you planning to harm yourself, take your life? Have you decided how you are going to kill yourself? • Do you own a gun? Do you have these pills at home? Have you collected the things that you need to carry out your plan? • When do you think you would take your life? Have you decided when you would do it? • Have you attempted to harm yourself or attempted suicide before?

16. DO: • Get HELP or support from a supervisor or clinical person trained in crisis services as soon as possible. • Let the person know that you are concerned and willing to help. • Express empathy for what they are going through • Encourage the person to do most of the talking • State that thoughts of suicide are common and do not have to be acted on • Involve the person in what should be done, who should be told, and where to seek help

17. Do Not • Leave the person alone • Use guilt or threats, such as “you will ruin your children’s life if you kill yourself.” “People who take their own lives do not go to heaven.” • Promise to keep their plan a secret

18. You are listening to me when you are: • Genuine, attentive, not fidgeting, open body posture, sitting next to me rather than directly opposite of me, making comfortable eye contact. • Really trying to listen to me even though I am not making much sense. • You grasp my point of view, even when it is against your own convictions.

19. You are NOT listening to me when you • Offer me religious solace, if I am not ready. • Say you understand; you have an answer to my problem, you finish my sentences; tell me about your experiences, which makes mine seem unimportant; you refuse my thanks, saying you really haven’t done anything.

20. Homicide or Danger to Others (DTO) • Often suffering from similar pain as someone who is DTS, but is possibly angry, has a history of angry outbursts or has harmed others in the past.

21. What to do • Gather as much information as possible, such as (name, relationship, location of the potential victim): • Who is in danger? • Is there a plan? • Are the means to carry out the plan available? • When and where will this occur? • If there is a plan, the person in danger MUST be notified and the law enforcement contacted immediately. • A contract for safety should occur and if possible remove the “means of the plan.”

22. What to do • Be sure to give the person space, DO NOT touch them without permission • Maintain your own safety, and have access to an exit • Use short, simple sentences, comply with reasonable requests, use positive words, be aware of what may exacerbate the person’s fear and aggression.

23. Substance Abuse • Use ALGEE • Try to find out what has been taken, when it was taken, and how much was consumed • Do NOT leave the person alone or give them anything to eat • Express your concerns, “I am concerned about how much you have been drinking lately.” • Assess for suicide or self-harm:

24. Withdrawal • Unconscious • Confused • Hallucinating • Irregular, shallow, or slow breathing • Cold, clammy, pale, or bluish skin • Vomiting • Seizures • ****MEDICAL ATTENTION IS NEEDED IMMEDIATELY****

25. PTSD • an anxiety disorder that can occur following the experience or witnessing of a traumatic event. A traumatic event is a life-threatening event such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood (Pub MED, 2010). • Domestic Violence, including physical abuse, emotional abuse, and verbal abuse • Rape (Victim and Bystander)

26. Domestic Violence • Encourage a “Safety Plan” • Discuss a “Safe Place” • The National Domestic Violence Hotline: • 1-800-799-Safe (7233)

28. Rape and Sexual Violence • In 2007, 31.3 million people were survivors of rape • Sexual Violence victims includes victims who were attacked, and well as those who have witnessed sexually violent crimes (bystanders). • http://www.azrapeprevention.org

29. Resources: • Maricopa County Crisis Line 602-222-9444 • NARBHA crisis 1-877-756-4090 • Pima County and Southern AZ 520-622-6000 • Domestic Violence 1-800-799-SAFE (7233). • Rape, Abuse, and Incest National Network (RAINN) 1-800-656-HOPE • Northern AZ Center Against Sexual Assault (Flagstaff) 928-774-6627 • Office of Navajo Women and Families 928-871-6627 • Tucson Center for Women and Children 520-795-8001 • Alcoholics Anonymous 602-264-1341 • Narcotics Anonymous 480-897-4636 • Crisis Pregnancy Center 480-966-5683 • Community Information and Referral 602-263-8856

30. Thank you! • Questions • Homework: Learn more! • Time for Practice: Today is your second meeting with Mr./Mrs. Owens. Mr./Mrs. Owens has recently lost her job and seems more “down” then usual. He/She is tearful and notes that He/She has been drinking daily and feels “unmotivated,” He/She has been job searching but notes that no one is going to hire him/her because he/she is old, overweight, and has a limited college education. Please assess and provide support to Mr./Mrs. Owen for DTS/ DTO concerns.

31. Practice, practice, practice. . . . • #2 • Tara is 18 years old an in college. She has recently moved out from her foster parents and into her boyfriends home. She describes her childhood as “inconsistent”, and “violent.” This is your 4th session with her and you notice several “cuts” on her arms. . . • #3 • Todd has been expressing his frustrations with his step father with you for the past three sessions. He notes today, “If that guy puts his hands on my mother one more time, I will kill him!” Assess Todd for DTO.