Suicide Prevention

1. Suicide Prevention Prepared by: Jim Messina, Ph.D. Clinical Director Be-COS Inc.

2. Suicide Facts • Tenth leading cause of death in America - in 2009 there were 36,909 suicides (100.8 suicides per day; 1 suicide every 14.3 minutes) • 3.7 times more males than female commit suicide • Rates of suicide are highest among the elderly – 80 years or older which is 50% higher than that of the nation as a whole (all ages) • Suicides ranks as 3rd cause of death among young (15-24) Americans behind accidents and homicides • Firearms are most commonly utilized method of completing suicide in all groups – More than 50.8% used this method • Poisoning is most common method of suicide for women • Caucasians (13.5 per 1000) have higher rate of completed suicides than African Americans (5.1 per 1000) • In the past year adults reported: more than 8 million having serious suicidal thoughts; 2.5 million making suicide plan and 1.1 million suicide attempts • Suicide rates traditionally decrease in times of war and increase in economic crises

3. Suicide 10th Leading Cause of Death

4. Research on Suicide • Estimated 25 attempts for each death by suicide • Risk of attempted suicide (non-fatal) greatest among females and the young • Ratios of attempted to complete suicides for youth estimated between 100-200 to 1 • 90% of completed suicides had one or more mental disorder • Diagnoses with greatest risk: depression, schizophrenia, drug and/or chemical dependency and conduct disorders (in adolescents) • Risk of suicide increased by more than 50% for depressed individuals – 60% of completed suicides • Risk of suicide in alcoholic is 50 to 70% higher than general population • Feelings of hopelessness (no solution to my problem) found to be more predictive of suicide risk than a diagnosis of depression per se • Socially isolated individuals are generally found to be higher risk for suicide • Vast majority of individuals who are suicidal often display cues & warning signs

5. Who are at risk for suicidal behavior • Individuals: • With mental and/or substance use disorder • Bereaved by suicide • In justice and child welfare settings • who engage in non-suicidal self-injury • Who have attempted suicide • With medical conditions • Who are lesbian, gay, bisexual or transgender (LGBT) • Who are American Indians/Alaska Natives • Who are members of the Armed Forces and veterans • Who are men in midlife and older men

6. Warning Signs of Suicide • IS PATH WARM? • I Ideation • S Substance abuse • P Purposelessness • A Anxiety • T Trapped • H Hopelessness • W Withdrawal • A Anger • R Recklessness • M Mood Change

7. Acute Risk for Suicide • Warning signs of Acute Risk • Threatening to hurt or kill self or talking of wanting to hurt self • Looking for ways to kill self by seeking access to firearms, available pills, or other means • Talking or writing about death, dying or suicide when these actions are out of the ordinary

8. Additional Warning Signs • Increased substance (alcohol or drugs) use • No reason for living; no sense of purpose in life • Anxiety, agitation, unable to sleep or sleeping all the time • Feeling trapped – like there is no way out • Hopelessness • Withdrawal from friends, family and society • Rage, uncontrolled anger, seeking revenge • Acting reckless or engaging in risky activities, seemingly without thinking • Dramatic mood change

9. Major Risk vs. Protective Factors • Major risk factors for Suicide: • Prior suicide attempt(s) • Substance abuse • Mood disorders • Access to lethal means • Major Protective Factors: • Effective mental health care • Connectedness to individuals, family, community & social institutions • Problem-solving skills • Contracts with caregivers

10. Depression and Suicidal Thinking • Major Depression is most commonly associated with suicide • The risk of suicide in people with major depression is about 20 times that of the general population • Lifetime risk of suicide among patients with untreated depressive disorder is nearly 20% (Gotlib & Hammen, 2002) • Suicide risk among treated patients with depression is 141 per 100,000 (Isacsson et al., 2000) • About 2/3 of people who complete suicide are depressed at the time of their deaths • About 7 out of every 100 men and 1 out of every 100 women who have been diagnosed with depression in their lifetime will go on to complete suicide • People with multiple episodes of depression are at greater risk for suicide than those who have a single episode • People who have dependence on alcohol or drugs in addition to being depressed are at greater risk for suicide

11. How to Identify a Suicidal Person • Talks about suicide, death, and/or no reason to live; feeling trapped or in unbearable pain; being a burden to others • Is preoccupied with death and dying & looking for a way to kill oneself • Withdraws from friends and/or social activities or feels isolated • Has a recent severe loss (esp. relationship) or threat of a significant loss • Experiences drastic changes in behavior • Loses interest in hobbies, work, school, etc. • Prepares for death by making out a will (unexpectedly) and final arrangements • Gives away prized possessions • Has attempted suicide before • Takes unnecessary risks; is reckless and/or impulsive • Loses interest in personal appearance • Increasing use of alcohol or drugs • Expresses a sense of or is faced with a situation of humiliation or failure • Has a history of violence or hostility or showing rage or talking about seeing revenge • Has been unwilling to “connect” with potential helpers

12. What you can do • If you believe someone is at risk of suicide • Ask them if they are thinking about killing themselves (This will not put this idea in their heads, or make it more likely they will attempt suicide) • Take the person to the emergency room and seek help from a medical or mental health professional • Remove any objects that could be used in a suicide attempt • If possible do not leave the person alone • Call the Suicide Hotline of the U.S. National Suicide Prevention Lifeline: 800-273-TALK (8255) • Figure out the Lethality of the Suicidal Gesture

13. Questions to Ask to Rule Out the Lethality of the Suicide Threat • How lethal are the suicidal thoughts, gestures, or actions which the person is engaged in? To figure out how lethal, answer the following: • Does the person have a means of suicide in mind? • Is this means of suicide readily available to person at this time? • Is this an effective way to kill oneself? • Have person ever used this means before to attempt suicide in the past? • Is person ready to use this means of suicide at this time? • Is nobody living with person at this time who can take control of this means of person killing self? • If you answered yes to all six items then the person is very lethal and needs immediate helpand make sure to get a counselor or crisis center involved as soon as possible • Lastly: Call the Suicide Hotline of the U.S. National Suicide Prevention Lifeline: 800-273-TALK (8255)

14. 1st Myth & Truth in Suicide Prevention • Myth: Asking about suicide will plant the idea in a person’s head. • Reality: Asking about suicide does not create suicidal thoughts. The act of asking the question simply gives the person permission to talk about his or her thoughts or feelings.

15. 2ndMyth & Truth in Suicide Prevention • Myth: People who talk about suicide don't complete suicide. • Reality: Many people who die by suicide have given definite warnings to family and friends of their intentions. Always take any comment about suicide seriously.

16. 3rd Myth & Truth in Suicide Prevention • Myth: There are talkers and there are doers. • Reality: Most people who die by suicide have communicated some intent. Someone who talks about suicide gives the guide and/or clinician an opportunity to intervene before suicidal behaviors occur.

17. 4th Myth & Truth in Suicide Prevention • Myth: Suicide happens without warning. • Reality: Most suicidal people give clues and signs regarding their suicidal intentions.

18. 5th Myth & Truth in Suicide Prevention • Myth: Suicidal people are fully intent on dying. • Reality: Most suicidal people are undecided about living or dying, which is called “suicidal ambivalence.” A part of them wants to live; however, death seems like the only way out of their pain and suffering. They may allow themselves to "gamble with death," leaving it up to others to save them.

19. 6th Myth & Truth in Suicide Prevention • Myth: If somebody really wants to die by suicide, there is nothing you can do about it. • Reality: Most suicidal ideas are associated with treatable disorders. Helping someone find a safe environment for treatment can save a life. The acute risk for suicide is often time-limited. If you can help the person survive the immediate crisis and overcome the strong intent to die by suicide, you have gone a long way toward promoting a positive outcome.

20. 7th Myth & Truth in Suicide Prevention • Myth: He/she really wouldn't commit suicide because… • • he just made plans for a vacation • • she has young children at home • • he made a verbal or written promise • • she knows how dearly her family loves her • Reality: The intent to die can override any rational thinking. Someone experiencing suicidal ideation or intent must be taken seriously and referred to a clinical provider who can further evaluate his/her condition and provide treatment as appropriate.

21. 8thMyth & Truth in Suicide Prevention • Myth: Asking a depressed person about suicide will push him/her to complete suicide. • Reality: Studies have shown that patients with depression have these ideas and talking about them does not increase the risk of them taking their own life.

22. 9thMyth & Truth in Suicide Prevention • Myth: Improvement following a suicide attempt or crisis means that the risk is over. • Reality: Most suicides occur within days or weeks of "improvement," when the individual has the energy and motivation to actually follow through with his/her suicidal thoughts. The highest suicide rates are immediately after a hospitalization for a suicide attempt.

23. 10thMyth & Truth in Suicide Prevention • Myth: Once a person attempts suicide, the pain and shame he/she experiences afterward will keep him/her from trying again. • Reality: The most common psychiatric illness that ends in suicide is Major Depression, a recurring illness. Every time a patient gets depressed, the risk of suicide returns.

24. 11thMyth & Truth in Suicide Prevention • Myth: Sometimes a bad event can push a person to complete suicide. • Reality: Suicide results from having a serious psychiatric disorder. A single event may just be “the last straw.”

25. 12thMyth & Truth in Suicide Prevention • Myth: Suicide occurs in great numbers around holidays in November and December. • Reality: Highest rates of suicide are in May or June, while the lowest rates are in December.

26. In Conclusion • Prevention may be a matter of a caring person with the right knowledge being available in the right place at the right time. • Are You Ready?

27. Resources on Suicide Prevention • National Suicide Prevention Lifeline: http://www.suicidepreventionlifeline.org/ • CDC’s Suicide Prevention: http://www.cdc.gov/ViolencePrevention/suicide/index.html • Surgeon General’s Suicide Prevention Strategy 2012: http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/index.html • American Society of Suicidology: http://www.suicidology.org/home • SAMSHA Suicide Prevention: http://www.samhsa.gov/prevention/suicide.aspx • Veterans Crisis Line: http://veteranscrisisline.net/ • VA Suicide Prevention: http://www.mentalhealth.va.gov/suicide_prevention/index.asp • DoD/VA Suicide Outreach: http://www.suicideoutreach.org/ • SPRC-Suicide Prevention Resource Center: http://www.sprc.org/ • National Alliance for Suicide Prevention: http://actionallianceforsuicideprevention.org/ • American Foundation for Suicide Prevention: http://www.afsp.org/ • YSPP-Youth Suicide Prevention Program: http://www.yspp.org/ • SAVE-Suicide Awareness Voices of Education: http://www.save.org/ • Yellow Ribbon Suicide Prevention Programs: http://www.yellowribbon.org/