SUICIDE ASSESSMENT AND INTERVENTION

1. SUICIDE ASSESSMENT AND INTERVENTION

2. Definition of Crisis A student is in crisis when his/her normal coping skills are overwhelmed by current life events. The student experiences subjective distress and impaired social, academic, emotional and/or physical functioning.

3. Definition of Crisis - cont. This may include: suicidal or homicidal ideation or behavior, grief reaction to any type of loss, bizarre thoughts, drug intoxication, acute anxiety, impulse control problems, school problems, and developmental issues.

4. A crisis does not exist when: • A student requests information only • A third party calls to consult regarding a non-emergency • A student reports that s/he just needs someone to talk to about a non-crisis or non-emergency situation

5. .Evaluating Suicide Potential or Assessment of Lethality Suicide Lethality Statistics: Colorado has the fifth highest per capita suicide rate in the nation Suicide is second highest cause of death in college students after accidents

6. Suicide Lethality - cont. Seventy-five percent (75%) of those who commit suicide will give clues (25% give no clues....just as important)

7. Categories of self-destructive Behavior: Ideation - suicidal thoughts - very common Threat - saying or doing something that indicates a self-destructive desire Gesture - a self-destructive act of low lethality, usually symbolic Attempt - serious effort to end one's life

8. Risk Factors Age and Sex Males attempt less often than females, but use more lethal means (i.e., more men commit, more women attempt). However, the gap is closing and threats from women should never be taken lightly. As age increases, suicidal risk goes up for both sexes, but the danger increases much more for males than females with age. However, college students also have increased risk and rates (2nd leading cause of death after accidents).

9. Suicidal Plan- Seriousness and immediacy increase as: • Person has a specific, clear plan, including method, time, and place. • Person has a means available or easily accessible. • The method chosen is more dangerous. Guns, hanging, jumping, and car-ramming are generally more dangerous than wrist-slashing and pills. • The person has been thinking about suicide for a long time.

10. Prior Attempts • Many people who commit suicide have a history of prior attempts, threats, or gestures. • Look for patterns, i.e., whether attempts are getting more lethal and more frequent. • Especially high lethality if past attempt(s) was serious (nearly worked), violent, or carefully planned.

11. Depressive Symptoms • Hopelessness • Helplessness • Negative expectations for the future • Withdrawal from people and situations through either avoidance or escape • Change in behavior, such as decline in school attendance and achievement. • Loss of appetite • Sleep disturbance • Decrease in concentration

12. Amount of Control The less control a person has, the higher the immediate risk. Evidence of a loss of control: Psychotic behavior – hallucinations History of poor impulse control or poor judgement Use of alcohol or drugs increases risk - intoxication plays a role in the majority of all completed suicides

13. Precipitating Events (Stress) RECENT LOSS - is indicative of higher lethality • Loss of significant-other, death, and divorce • Loss of job – self-esteem, financial support • The loss may be impending rather than actual

14. Resources If the person’s resources, financial ($, job) or emotional (friends and family) are lost, the risk goes up accordingly

15. Isolation Emphasis on feeling psychologically isolated, not just physically The person who is a “loner” or feels very alone is a higher risk Family History/Family or Campus Turmoil

16. History of Turmoil Family history of depression, psychosis, suicide, abuse, alcoholism Instability of relationships at home or on campus increases risk Presence of incest, child abuse, spousal violence

17. Your Gut Reaction If your gut feeling goes against the objective data, check out what you are feeling with the person. Trust yourself.

18. CRISIS INTERVENTION GUIDELINES • Most suicidal people are ambivalent • Address the sense of hopelessness. Offering hope through support and help. Generate a alternative courses of action • Acknowledge their pain

19. CRISIS INTERVENTION GUIDELINES • When you arrive on the crisis scene, take charge of the situation. You will need to be directive but calm • Assess if related parties also need assistance and deal with them • Present a contrast to the student's panic. Speak clearly, in a moderate pace, not too loud, maintain appropriate eye contact. Work on developing some trust first

20. CRISIS INTERVENTION GUIDELINES You will need to be more active and directive than usual, making decisions for the suicidal person that s/he is unable to make. Your ability to model calm, clarity, and decisiveness will nurture that part of the student

21. CRISIS INTERVENTION GUIDELINES • Don't give false assurances, e.g.. "Everything will work out." You can't guarantee this! • Identify the student's prior successful coping strategies • The goal is to problem solve, not analyze or do therapy

22. CRISIS INTERVENTION GUIDELINES • Don't take sides or assign blame • Don't argue if the student is criticizing you or something that you said • Discuss options for action and the student's opinions before making a decision. But remember, you are more able to make a realistic decision than a student in crisis. Stick to your recommendation despite objections.

23. CRISIS INTERVENTION GUIDELINES • Solutions should be workable and based on the resources at hand • Goals should be well defined and limited • Mobilize environmental and "significant other" support

24. CRISIS INTERVENTION GUIDELINES • A student in crisis may test your caring by. This is a natural stage. But if your frustration level is approaching a critical level, consult with other staff • A manageable plan of action needs to be developed and an agreement made that the suicidal person will follow through on the initial steps. Follow-up counseling must be part of the plan

25. CRISIS INTERVENTION GUIDELINES Avoid a philosophical discussion concerning the right to die. You can acknowledge that the student does have that option (responsibility). This is often a control issue. Once the student feels that s/he can retain this power, s/he is open to considering alternatives.

26. CRISIS INTERVENTION GUIDELINES • Do not say you will keep information secret of confidential. You may lose a friendship but save a life.

27. CRISIS INTERVENTION GUIDELINES Assessment for Intent & Immediacy “Help, what should I say or do?!!!” Does the person think s/he would actually go through with it? And if so, how soon? Do not be afraid to ASK to following questions….

28. CRISIS INTERVENTION GUIDELINES Ask: Have you been thinking about taking your life? How would you kill yourself? Do you have a plan? Do you have the means available for the plan?

29. CRISIS INTERVENTION GUIDELINES Ask: Have you ever attempted before? Do you feel you will be safe for a short-time until we can arrange help? What has been keeping you alive so far? What does the future hold for you?

30. CRISIS INTERVENTION GUIDELINES The more specific, well thought out, and serious the plan, the higher the risk that the situation is life threatening. The intervention need becomes more immediate.

31. CRISIS INTERVENTION GUIDELINES If life threatening situation: • Do not leave the person alone if they are not safe. • Call UNC police if assistance is needed - 351-2245 • Contact Hall Director • Follow instructions given by police and Hall Director

32. CRISIS INTERVENTION GUIDELINES The most important intervention is to LISTEN! If a person really wants to commit suicide, no one can stop him or her, including you. But, you can be prepared and do what you can.

33. SUMMARY It's important to look at overall patterns and not jump to conclusions based on a few significant signs. Nevertheless, some signs are most indicative of lethality: previous attempts, specific plan, availability of means, and drug use

34. Smaller Group Interactions