Suicide Risk Assessment Training For Professionals

1. Suicide Risk Assessment Training For Professionals Melissa Witmeier Florida Youth Suicide Prevention Project University of South Florida & Florida Council for Community Mental Health

2. Objectives for Training • Scope of Suicide • Asking the Suicide Question • Suicide Risk Assessment Questions • Safety Planning • Resources

3. Did anyone have a class in college focused solely on suicide prevention, intervention and postvention? Or been trained as Crisis Intervention Hotline Counselors? How many of you have a formal Suicide (only) Risk Assessment Form and Safety Planning Document at your organization? Who here today has gone through specialized suicide intervention training beyond college like QPRT or AMSR in the last 5 years? If you have these documents, how many of you use these forms every time a client expresses suicidal ideation?

4. Importance of Doing a Suicide Risk Assessment Let’s do the math…

5. About 25% of the population may THINK about suicide in a 12 month period of time. According to the US Census Bureau, there are 313.9 million people living in the United States right now. About 78.5 million people in the US need to talk to someone in a given year because Suicide is an OPTION.

6. Suicide is an OPTION Thinking about Suicide But it is NOT for me! • Starting to Make Plans • Suicide Attempt • Died by Suicide

7. High vs Low Risk

8. Scope of Suicide

9. 39,518completed suicides in 2011 • About one person every 13.3minutes dies by suicide • Average of over 108people per day • About 25 attempts for every death by suicide • Suicide is the 10thranking cause of death in the U.S. Homicide is 16th • Suicide rates of middle aged adults (age 35-64) increased 28% since 1999 (m=32%, w=27%) • 4 times male completions to female • 3 times female attempts to male • More teenagers and young adults die from suicide than cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza and chronic lung disease COMBINED. • 5,104 youth aged 10-24 died by suicide in 2011 STATISTICS “Suicide is a national public health problem.” – David Satcher, MD Former Surgeon General of the United States

10. Stephen R. Covey: The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change “Most people do not listen with the intent to understand; they listen with the intent to reply.” How are your active listening skills?

11. You are now a SUPER SLUETH… But you must be a good listener!

12. Seeing the Storm…

13. Let’s meet Kate… • Details known about client: • 14 year old, 9thgrade female • Straight A student in the IB Advanced Program in her highschool • Active in several youth activity groups including sports and leadership • Parents are married and both are gainfully employed • Has one sibling in a middle school • Quiet and reserved during school, but has peers in all classes • Home room teacher recently overheard Kate say “If my boyfriend breaks up with me, I don’t think I will be able to handle all of this. It’s just too much!” • She has been referred to talk to a Guidance Counselor

15. To Begin Any Suicide Risk Assessment… Ask the “S” Question?

16. You Must Ask The Question. I am worried about you. Are you thinking about suicide? OR… Are you thinking about killing yourself?

17. Self Harm Behavior Have you ever hurt yourself? or Do you think about hurting yourself? Hurting vs. Killing

18. Current Suicide Plan • Have you thought about: • How you would kill yourself? • Do you have access to the means? • When would you kill yourself? • Where would you kill yourself? • Is anyone involved in your suicide plan? (Risk or Protective Factor)

19. Past Suicidal Behavior Have you thought about suicide in the past? (Explore past method and plan) Have you tried to kill yourself in the past? (When and how many times)

20. FACT “Having attempted suicide once makes a person significantly more likely to attempt suicide in the future and multiple past attempts indicate a highly elevated future risk.” -Dr. Thomas Joiner

21. Substance Use or Abuse • Are you currently using any substances like drugs or alcohol? • How much are you using? • Has this changed over the last few months to a year? Why is this VERY important?

22. FACT Individuals with a substance use disorder (ie, either a diagnosis of abuse or dependence on alcohol or drugs) are almost 6 times more likely to report a lifetime suicide attempt than those without a substance use disorder. (Kessler, Borges , Walters, 1999)

23. Risky Behavior • Are you impulsive? • Do you participate in activities that are risky, reckless or put your life in danger?

24. FACT Teens engaging in risky behaviors are at increased odds for depression, suicidal ideation, and suicide attempts. Although causal direction has not been established, involvement in any sex or drug use is cause for concern, and should be a clinical indication for mental health screening for girls; both boys and girls should be screened if engaging in any marijuana or illegal drug use. (Hallfors, Waller, Ford, Halpern, Brodish, Iritani, 2004)

25. Anger • Suicide is not always about depression… • How angry do you get? • Do you lose your temper often? • Are you spiteful or vindictive? • Do you get in physical or violent fights? • Are you verbally abusive?

26. Do you know the difference??? Risk Factors vs. Warning Sign

27. Risk Factors • Previous suicide attempt • Mental health disorder • Death or loss especially if by suicide (check for family history of suicide) • Helpless or hopeless • Drastic changes – social, work • Bullyingor isolation or burden • Substance abuse Tell me more…

28. Protective Factors • Access to mental health and community resources • Family and community support • Activities, goals, responsibilities • Cultural and religious beliefs

29. Listen to the side that wants to die as it will lead you to the side that wants to live. If you lead with the side that wants to live, it is YOUR conversation…Not the person at risk.

30. Review of Suicide Risk Assessment Items • Ask “S” Question • Current Plan • Past Suicidal Behaviors • Self Harm Behavior • Risky Behaviors • Substance Use or Abuse • Anger • Ambivalence – Life vs. Death • Access to Safety Net

31. Now what about Kate? Let’s ask her some questions?

32. What you don’t know about Kate • Kate often thinks about killing herself • Her father has guns in the house and Kate has used them with her Dad • Her best friend of 6 years has recently moved away • Her father is an alcoholic and often verbally abusive • Her mother struggles with depression • Kate has recently started drinking alcohol to help with the stress at school • Kate’s boyfriend has stopped calling • Kate is shop lifting with her new group of friends • She has recently started using a paperclip to scrap herself, being too afraid to use the razor her friend gave her

33. Safety Planning Guidelines • Warning signs • Internal coping strategies • Social contacts that may distract from crisis • Friends or family members that may offer help • Professionals or agencies to contact for help • Making the environment safe (Means restriction) Provided By Suicide Prevention Resource Center (SPRC)

34. Baker Act It can be initiated by judges, law enforcement officials, physicians, or mental health professionals. A “Baker Act” temporarily suspends an individual’s liberty when there is substantial evidence suggesting imminent risk of harm to self or other. This risk may be either intentional (such as suicide or homicide) or unintentional (such as acute psychotic break).  

35. Finally… Document, Document, Document and… Sign it TOGETHER! Give a copy to the client and put a copy in the file

36. Resources • “It’s Time to Talk about it” A Family Guide for Youth Suicide Prevention • 211 or Local Crisis Hotline • 800-273-TALK or 800-SUICIDE – NSPL • Support Groups • Community or Health Organizations • Activities – past, present and future • Be creative and put your thinking cap on!

37. Questions?