Depression Awareness and Suicide Prevention Training

1. Depression Awareness and Suicide Prevention Training Welcome to the on-line depression awareness and suicide prevention training. In this training you will learn how to recognize and respond when a student is in distress, needs help or may be thinking about suicide. Brought to you by University Counseling & Testing Center & Oregon College & University Suicide Prevention Project Special funding from Substance Abuse and Mental Health Services Administration. Thanks also to University Health Services at Univ. of California, Berkeley. The training will take approximately 40 minutes.

2. Depression is increasingly common among college students • Universities across the country are seeing a rise in the numbers of depressed students, as well as those who are struggling with other serious mental health concerns, including eating disorders, bipolar disorder, and alcohol/drug addiction. • Multiple factors can influence a student’s mental health – academic pressure and competition, alcohol and drug use, family and relationship difficulties, medical and psychological problems, and under-developed coping skills. Consider that: • In 2007, 46% of UO students surveyed said that they had felt so depressed during the last year they could not function.2 • 9.6% of UO students reported that they had seriously considered suicide.2 1. Furr, Susan, et al, Suicide and Depression Among College Students. Professional Psychology: Research & Practice, 2001, 32, 97-100 2. American College Health Association Survey, Spring 2007

3. Why train non-mental health professionals? • Research suggests that close to half of suicidal students tell no one. Only a small percentage currently see a therapist. Therefore, reducing suicide on campus depends on a safety net that includes peers, resident advisors, faculty and staff. • Ideally, this safety net can steer students to professional help before they become suicidal. • Caring relationships with advisors and mentors reduces the sense of isolation that often plays a role in suicide.

4. Why is mental health training important for you? • You may be worried about a student and not sure what to do. You may have read a paper or received an email in which a student reveals personal problems that set off alarm bells & go beyond your expertise. • You may supervise others who have questions about students in distress. • While the focus of this training is primarily about responding to students, you may be concerned about a colleague who has been depressed and withdrawn.

5. Some situations you may experience • Students with noticeably declining behavior. For instance, a student who used to attend class regularly begins to look disheveled, stops coming to class, and misses exams. • International students with no family or friends here. Suppose the student’s academic situation is in jeopardy and you’re worried that s/he’s so depressed that suicide is a real risk. Students making alarming comments, such as, “What’s the point of living,” or “People would be better off without me.” It’s clear that they’re thinking about dying, but you don’t know how to begin to talk with them about getting help

6. Understanding your role As a university faculty or staff member, you can be a “gatekeeper” for students getting help. Students in distress often turn to those they know and trust. This online training will guide you through three steps that can help you assist a student who is distressed and perhaps at risk for suicide: 1.Learn to spot the warning signs 2. Know the appropriate resources 3. Connect the person to help

7. Signs of distress – when to be concerned about a student The following behaviors indicate that a student is distressed and might benefit from a referral for counseling: • Overwhelmed to the point where everything is a problem • Significant changes in academic performance or behavior, for instance, multiple requests for special consideration, significant decline in class attendance, participation and/or grades • Significant physical changes, such as decline in hygiene, appearing fatigued • Strange behaviors and impaired thinking such as paranoia, incoherent speech, inappropriate boundaries and bizarre behavior. This may come across in written work that is not explicitly meant to be creative. • Intense emotional reactions such as intense anxiety or irritability, agitation, prolonged or frequent crying • Threatening statements and behaviors. This includes making references to suicide or threatening remarks and stalking behavior.

8. Depression is one of the most common reasons students seek counseling. While it’s normal for people to feel sad from time to time, clinical depression goes beyond sadness. It tends to be pervasive, affecting not only one’s mood, but one’s work, relationships, self esteem, health and outlook on the future. Clinical depression is also more long lasting, lasting two weeks or more. While some depressed people appear sad, in other instances, depression expresses itself by the absence of emotion or emotional numbing. Such individuals may appear flat, subdued, even listless.

9. Signs of depression include multiple symptoms lasting over a period of several weeks In class, depression may show itself by fatigue, missed morning classes, declining hygiene, and poor concentration. Other common symptoms include: • Feeling irritable or crying for no reason • Withdrawing from social contacts • Sadness or low mood • Loss of interest in activities that used to be enjoyable • Feeling worthless or unnecessarily guilty • Restless or slowed movements and speech

10. Clinical depression or just a mood? You don’t need to diagnose a student. Yet, knowing some of these symptoms can alert you to the fact that a student may be depressed. The important point to remember is to watch for these signs and to refer any student you think may be depressed to a mental health professional.

11. Some facts about depression • Depression is not a sign of weakness • It is an condition that affects people of all ethnicities, nationalities and cultural backgrounds • It will not just “go away” if it is ignored • Although most depressed people are not suicidal, most suicidal people are clinically depressed.

12. Suicide is a permanent solution to a temporary problem • Suicide often is an impulsive act. • Consider that most students who are suicidal seriously contemplate suicide for one day or less. • Most students who attempt suicide do so under the influence of alcohol or drugs. • Of 515 individuals who were restrained from jumping off the Golden Gate Bridge, only 5-7% had completed suicide in a 27 year follow up period. Other long term studies show similar results.1 1. Seiden, Richard. Suicide & Life Threatening Behavior. Vol.8 (4), Winter 1978

13. Suicide is a coping strategy • Suicide is often seen as a means to end unbearable pain. Most people don’t want to die, they just want the pain to end. • People can learn to manage their emotional pain in life affirming ways, including by learning healthy coping strategies. • An estimated 60-64% of young adults who commit suicide have a mood disorder. Mood disorders can be treated effectively. • When pain is held, healed and transformed, it contributes to the well being and evolution of society. Those who bear it often become artists and writers, healers, peace makers and passionate advocates for the oppressed.

14. Myths about suicide • Many misconceptions exist about suicide • These misconceptions can stand in the way of getting help to those at risk. • Take any mention of death or suicide seriously. • Early recognition and treatment of depression and other mental illnesses is the best way to prevent suicide.

15. Myths about Suicide #1 Myth: Asking about suicide will plant the idea in someone’s head. FACT: Asking about suicide in a straightforward and caring way will not make one suicidal. It will convey your concern and invite disclosure.

16. Myth about Suicide #2 Myth: A person who attempts suicide almost never shows any warning signs. FACT: Warning signs are often present prior to serious suicide attempts.

17. Myth about Suicide #3 Myth: Once people decide to take their own life, nothing can be done to stop them. FACT: Most people are ambivalent about suicide. Very often it can be prevented.

18. What are the risk factors for suicide? • Hopelessness – the sense that nothing and no one can improve their situation • Easy access to means of harming themselves (e.g., a gun, pills) • History of past suicide attempts or suicide in the family • Recent major loss (social, academic, etc.) • Impulsive or aggressive tendencies • Alcohol and other substance abuse • Untreated mental illness, especially depression, bipolar disorder and psychosis • Lack of social support • Resistance to seeking help

19. Students have some unique risk factors . . . • Losing an important relationship. It may be the first such loss, and the student may lack the perspective that they will get over their sense of grief. • An academic loss disappointment, e.g., failing a class, not being admitted to a program. • Loss of financial aid. • Loss of support system when going away to college. (International, first year and graduate students are often at higher risk.)

20. Gender differences, suicide & depression • Depression may be harder to detect in young men since men tend to mask emotional pain and are less likely to reach out for help. • Young men often exhibit their depression in the form of anger, physical complaints and increased alcohol use. • While young women are more likely to attempt suicide, young men are 4-6 times more likely to complete suicide than young women.

21. Several protective factors reducethe risk of suicide • Skills in problem-solving, conflict resolution and handling difficult emotions • Strong social support network • Easy access to and willingness to participate in mental health care • Restricted access to lethal means • Cultural and religious beliefs that discourage suicide & promote self preservation • Meaningful commitments and obligations, e.g., pets, children

22. Undergraduate students Academic rigor and demands more than accustomed to First generation to attend college Isolation from family and friends Exposure to new beliefs and people Drugs and alcohol Overwhelmed by university experience Living on one’s own Residential living environment Family problems Disenchantment with college Lack of support from majority culture Graduate students Intense academic demands Competition and isolation Balancing work, school, home life Anxiety around oral exams, thesis, dissertation Relationship with faculty advisor Departmental politics Questioning academic path Decisions around career and childbearing, fast track vs. “mommy track” Tokenism, glass ceiling, gender politics Some sources of stress

23. How can you help? Express your concern directly and offer to help Be willing to listen with caring and without judgment Use a team approach: consult with others Be aware that the Family Educational Rights and Privacy Act(FERPA) allows you to disclose information about a student to Student Life and University Counseling Center staff

24. Tips - for helping a person in distress DOs: • Find a time to talk privately, without distractions • Communicate your concern to the student. Be specific - what have you noticed that raised your concern? • Ask how they’re feeling and listen to what they have to say • Ask if they have been thinking about suicide, e.g., “Are you feeling so bad that you’ve thought about hurting yourself . . . Have you thought about suicide?” If they have thought of suicide, how detailed are their plans? • Be supportive, remain calm, show that you care and reassure the student that they can get help

25. Tips -for helping a person in distress DON’Ts: • Don’t be judgmental or argue with the student about their feelings or choices • Don’t try to diagnose or to analyze the person • Don’t minimize the student’s feelings • Don’t ignore comments about suicide • Don’t be sworn to secrecy. • Don’t forget to seek support and consultation for yourself • Don’t put yourself in situations that feel unsafe • Don’t try to handle the crisis alone • Don’t be afraid to set limits

26. Asking about suicide can be challenging • Suicide is a socially tabooed subject. You may be afraid of saying the wrong thing or upsetting the person. You may feel overly responsible and unprepared: “They’re suicidal – now what do I do?” • You might want to practice talking about suicide with someone you know well, just to raise your comfort level. • By asking the question, you give the student permission to reveal this information. Most people who aren’t suicidal will tell you so. Asking someone about suicide will not put the idea in their head. • If the student denies that they are suicidal, yet your gut tells you something different, you are encouraged to consult with campus counseling staff.

27. Managing your reactions Give yourself permission to be human. It’s normal to feel anxiety or other difficult feelings. Talk to a supportive person beforehand and debrief afterward. You don’t need to be the expert or have all the answers. Know that you are not alone. Others on campus can assist you.

28. Making the referral • Toward the end of your conversation, if the student is struggling with suicide, significant depression or other emotional problems, the focus shifts toward referring him/her for professional help. • Make the referral after you have connected with the student and clarified the risk. • If you rush the referral, the student may feel like they are a “problem” you want to dispose of.

29. How to refer for counseling • Ask student if they have ever thought about counseling • Explain how counseling might be helpful. Perhaps you have referred another student who was helped or you yourself had a positive experience with therapy. • Provide information about the Counseling Center and how to access services. • Stress the confidentiality of counseling. Let the student know that meeting with a counselor doesn’t commit them to further treatment. • Normalize counseling, e.g., “The Counseling Center sees a lot of depressed students . . . That’s what they’re there for.”

30. More on referring for counseling • Use your relationship, e.g., “I care about you and want you to get the help you need.” • Some students who are closed to the idea of counseling are open to a medical approach, and vice versa • Offer to call ahead or walk the student over to the Center • Call the Counseling Center and consult if you are unsure of how concerned you should be or how you might help a particular student • Follow up with the student to see what the outcome of the referral was and how they are doing

31. Barriers to counseling Many students who might benefit from counseling don’t come to the Counseling and Testing Center. Some reasons include: • They don’t know about the services. • They don’t understand what counseling is. • They view help seeking help for a mental health problem as an admission of weakness or are otherwise ashamed to do so. In some cultures, to seek counseling implies that you must be “crazy.” • This is where your role is key. If you feel a student might benefit from professional help, you can suggest counseling as an option and encourage a student to utilize the mental health resources on campus.

32. What if the student is at suicide risk? • Take a more active role in getting the person to professional help. If a student, walk them over the Counseling Center. • Don’t take it upon yourself to handle the situation alone. • Always follow up with the student.

33. If a student is at imminent risk: • Don’t leave the student alone. • Do not put your own safety in jeopardy. • If on campus, call Campus Emergency at 6-6666. If off campus, call 911

34. What if the student needs help but is resistant it? • In 2005, UO adopted a Suicide Prevention Policy to help identify students at risk and to intervene with suicidal students who are resistant to getting help. This policy recognizes that members of the university community have a responsibility to maintain a standard of self care. Suicide is a real risk for students, and the effect of an attempted or completed suicide on the campus can be quite devastating and far reaching. • Faculty and staff are encouraged to consult with the Counseling Center. If a student is determined to be at significant risk, the Dean of Students Office will initiate a mandatory suicide assessment conducted by Counseling Center staff. • While this assessment may feel coercive, many students referred eventually come to appreciate the University’s concern and the opportunity to address the underlying reasons for their suicidality.

35. What counseling services are available to students? • The Counseling and Testing Center has a diverse staff of licensed mental health professionals and trainees. • All students who seek counseling receive an initial assessment. Based on this assessment and available resources, the student may be assigned an individual counselor, referred to one of several groups or referred for therapy in the community. • The Center sees roughly 1,600 students in a given year. • We work closely with psychiatrists and other Health Center staff when medication is a preferred treatment option. • The Center also operates a Crisis Line that is available nights and weekends except during University holidays and break periods.

36. How to Access Counseling The Counseling and Testing Center is located on the 2nd floor of the University Health and Counseling Center Building Hours: Monday thru Friday, 8 a.m. to 5 p.m. Telephone: 346-3227 • Students access services via a drop-in clinic which operates M-F 1–4. Students who cannot make these drop in hours are offered scheduled intakes. • Students with urgent needs can be walked over to see a counselor on duty during open hours. • Services are available and free to currently enrolled UO students Other Important Contact Numbers: • UO Crisis Line (eves & weekends) – 346-4488 • Office of Student Life – 346-3216

37. Consultation is the key • Err on the side of caution • If in doubt, consult with others • Don’t try to handle a critical situation on your own • The Counseling and Testing Center provides telephone consultation to staff and faculty

38. Applying what you’ve learned . . . To help you evaluate what you’ve learned from this presentation, we’d like to present you with some scenarios that you or a colleague may encounter

39. Consider scenario #1: You've noticed some changes in Sheila and are concerned about her. Sheila seems hyperactive and is becoming more agitated everyday. You hear her talking to herself and her behavior is beginning to scare other students. You mention this to a colleague and find out that other faculty are also concerned about her. What would be the best way to handle the situation?

40. Despression Awareness and Suicide Prevention Training What would be the best way to handle the situation? • A. Put an anonymous note in the student's mailbox suggesting that she visit the Counseling and Testing Center. • B. Ask to speak with the student privately. • C. Ignore the situation because you might aggravate things by drawing more attention to her. • D. Request that Student Life speak to the student because they are more experienced in these situations.

41. Recommendation: Answers B or D would both work depending on the situation. • An anonymous note could make the situation worse. The student may worry about who wrote the note and how she is being watched by her colleagues. • Do not ignore someone who needs help. We all need help and support at different times in our lives. It can be reassuring to know that our problems are real and that other people notice them. Offering someone help can be the beginning of their road to recovery. • Speaking privately with a student about the changes you've noticed shows that you care about the student's welfare. It also conveys to students that they do matter. • Student Life may have more information from others on campus. Staff are able to reach out and intervene with a student who comes to their attention.

42. Consider scenario #2: Marcos is an international student who you have known to be energetic and interested in many activities. For the past month, he has seemed to have little energy and often appears sad. He has always dressed casually, but recently he has looked disheveled and seems not to care as much about his appearance. You don't know Marcos very well, but you've chatted several times, so you decide to approach Marcos to ask if something is bothering him. He shrugs off the question and avoids you. You try one more time, and he breaks down in tears and says he cannot talk about it. What should you do next?

43. Despression Awareness and Suicide Prevention Training What should you do next? • A. Leave him alone. • B. Offer to "be there" for him when he wants to talk. • C. Call the Counseling Center for consultation about how to proceed. • D. Offer to go with Marcos to the Counseling Center and state that he doesn't have to talk about it with you but that he can talk confidentially with a counselor.

44. Recommendation: The best options here are a combination of B and C and D. Marcos is clearly experiencing something very difficult right now. Although you want to respect his privacy and desire to not discuss the issue, you should not just leave him alone. You can respect his privacy and still help him by saying something like, "okay, we don't have to talk about it, but I want you to know that we have a counseling center on campus where you can talk to a professional confidentially." Offering to "be there" for Marcos is a good option. It lets him know that you are a good resource and that you care about how he is doing. Make sure you follow up with Marcos and see how he is doing in a few days. You can always refer him to the Counseling Center even if things seem to be a little better, because chances are the original issue is still affecting him. You can call the Center for consultation. When a trained counselor hears about a situation, they may recognize potential issues that you may not. Offering to walk Marcos to the Counseling Center is another caring option. He may accept your offer and be relieved to have the option of talking to someone confidentially instead of to you. If he doesn't want you to go to with him, you can still give him information about how to access services. If Marcos' crying is inconsolable and he seems to need more support, find a private area for him to sit down and then proceed from there. Ask another person for help if necessary.

45. Consider scenario #3: Cleveland, who works in your office, has begun to display spotty attendance at work. Normally, he drops by your desk to talk, but lately he has stopped visiting with you. You’ve noticed that he looks depressed and that his old friends no longer call. Cleveland has classes at 8 a.m., but he tells you he just can’t get out of bed in the morning and has been missing class. Yesterday, you noticed that his mood suddenly had lifted. He offers to give another employee his mountain bike, saying that it was no longer needed. This morning Cleveland left his on-line blog open on the computer. The screen was open to a rambling note that made reference to global warming, the “futility of life” and the “big, quiet calm on the other side.” What should you do?

46. Despression Awareness and Suicide Prevention Training Which of these things might you do? • A. Alert someone else in the department so that you can work as a team to help the student • B. Call the student at their residence to check on their well being • C. Call Student Life • D. All of the above

47. Recommendation: All of the above are good options. If you sense that a student may be at risk for suicide, it is best to bring in more help. Others may have more information that bears on the student’s well being. In this situation, the student clearly has been depressed and seems to be thinking about suicide. His sudden improvement, along with giving away his Mt. Bike and the note on his blog, are red flags. While we can’t always prevent another’s suicide, caring relationships are a protective fact against suicide. Student Life could reach out and check on the student’s welfare. They can also involve parents if that is deemed to be helpful.

48. For further information . . . Here are some other resources you may find helpful: UO Suicide Resources: http://counseling.uoregon.edu/OUSPP_Handouts.htm Suicide Prevention Resource Center’s College Resources: http://www.sprc.org/featured_resources/customized/college_student.asp Suicide.org – Virtual articles on various topics: http://www.suicide.org/ American Foundation for Suicide Prevention: http://www.afsp.org/ (includes links for survivors of suicide)

49. Thank You Now that you’ve experienced this online training, we would appreciate it if you would take a few moments to evaluate the training. This will also allow us to send you a certificate of completion. If you are willing to complete this brief evaluation, please click the link below. To the Evaluation To the Survey