Evidence-Based Suicide Awareness and Prevention Social Worker and AD&G Board Approved

1. Evidence-Based Suicide Awareness and Prevention Social Worker and AD&G Board Approved National Institute of Crime Prevention

2. ADAM • Childhood friend – Dr’s kid • OCD – Big time • Teenage years – Private school – Drugs • Seeking answers • Religion – Became obsessed • World wasn’t clean enough – Too bad • SUICIDE BY GUN…………………….

3. In 2014, the suicide rate in the U.S. was 13 per 100,000 people, the highest recorded rate in 28 years. Over that year, 43,000 Americans killed themselves. • Nevada was 19.56 per 100,000 • Higher than average. WHY?

4. The U.S. suicide rate also rose 24% over the 15 previous years (1999-2014), with the rise correlated to the period's severe economic slump. • Note: Has your client had a decline in economic status?

5. Nevada Suicides • 2014 – 570 suicides 115 were female • Ages • 15-24 = 55 • 25-34 = 89 • 35-44 = 86 • 45-54 = 109 • 55-64 = 99 • 65-74 = 65 • 75 + = 67 Source: worldlifeexpectancy.com

6. 28.78 30.67 32.74 33.13 Per 100,00 population 2014 17.95

7. WHY SO MANY IN Nye County?

8. Silverton Video

10. Suicide has typically been viewed as a problem of teenagers and the elderly, and the surge in suicide rates among middle-aged Americans is surprising. • Ratio of attempts to • completed suicides is • 10 to 1……………..

11. 21,000 Traffic fatalities in 2014It is believed that several hundred of these fatalities were suicides. • More people now die from suicide than in car accidents, according to the CDC, which published the findings in Morbidity and Mortality Weekly Report. Suicide Traffic Crash story

12. Although most suicides are still committed using firearms, officials said there was a marked increase in poisoning deaths, which include intentional overdoses of prescription drugs, and hangings. Poisoning deaths were up 24 percent over all during the 10-year period and hangings were up 81 percent.

13. SUICIDE • Most common underlying disorder is DEPRESSION • Verbal suicide threats such as, “You’d be better off without me.” or “Maybe I won’t be around” • Expressions of hopelessness and helplessness • Previous suicide attempts • Daring or risk-taking behavior • Personality changes • Depression • Giving away prized possessions • Lack of interest in future plans

14. 8 OF 10 PEOPLE GIVE SIGNS OF INTENT • Ask direct questions without being judgmental. Determine if the person has a specific plan to carry out the suicide. The more detailed the plan, the greater the risk • Get professional help, even if the person resists • Do not leave the person alone • Do not swear to secrecy • Do not act shocked or judgmental

15. 8 OF 10 PEOPLE GIVE SIGNS OF INTENT • Trust your instincts that the person may be in trouble • Talk with the person about your concerns. Communication needs to include LISTENING • Do not leave the person alone

16. Specific things to look out for include: • Increased use of alcohol or drugs • Looking for a way to kill themselves, such as searching online for materials or means • Acting recklessly • Withdrawing from activities • Isolating from family and friends • Sleeping too much or too little • Visiting or calling people to say goodbye • Giving away prized possessions • Aggression

17. No single therapeutic approach is suitable for all people considering suicide  • Most suffer from isolation & loneliness • A permanent solution to what is most likely a temporary problem.

18. Have you done an involuntary commitment? • What were the circumstances?

19. Bill and I have --several times • Any suicide attempt • Any suicide threat • Unstable and threatening to harm someone else • Out of it on drugs. (Hospital with a hold) • Transported in police car early on (handcuffed) • Then Unit 52 van Baker Act story

20. Suicide Prevention • Major red flags: • Depression long term or situational May be caused by economic changes. Ego integrity vs despair ( CEO to care taker) Health decline of loved one: Thought it would be 18 months now has been 5 years. (psychologically unprepared) (Eddie)

21. Health change in them: • Suicide risk: • Chronic pain • Alzheimer's • Parkinson's (finger gun Jim) • Hopeless painful fatal disease

22. Less of a suicide risk: • Prostate cancer • Breast cancer • Diabetes • Manageable-treatable- usually not chronic pain

23. The Role of the Social Worker • Take the time to listen closely to your clients. • They may not just be complaining • They may be trying to tell you • They need serious help.

24. I can’t live like this any more. • I’m overwhelmed • I feel hopeless • They have had a change of important roles • Ego integrity vs despair • Constant pain • Fear of the future

25. Robin Williams • Premier Hollywood celebrity • Multi millionaire • Misdiagnosed with Parkinsons’ • Actually had Lewy body dementias ( LBD)

26. Robin Williams • Not on proper medications • Effects: Cognitive decline Fluctuations in alertness & attention Visual hallucinations Parkinsonian motor symptoms Impaired thinking / Sleep disorders Depletes dopamine

27. Robin Williams • Results in progressive intellectual & functional deterioration. • No cure • 2nd most common form of dementia

29. Involuntary Commitment • Persons authorized to file an application for the emergency admission of a person alleged to be a person with mental illness and a petition for the involuntary court-ordered admission of such a person to certain facilities or programs

30. Involuntary Commitment • Without a warrant: Take person into custody alleged to have a mental illness. Transport to a public or private facility OR Have law enforcement or non emergency medical.......PREFERRED

31. Involuntary Commitment • OR • You can apply for a District Court order. • For any peace officer to take into custody • You can try to persuade person to voluntary commit….

32. NEVADA FORM 2000 Patient brought to ER by EMS, etc. Page A of Legal Form 20005 completed Patient meets criteria & med eval establishes patient is medically cleared Patient meets criteria but med eval determines patient is not medically cleared. initial eval establishes patient does not meet criteria Patient is discharged or referred to CTC for detox, etc Page B of Legal 2000 completed. Patient transferred to a mental health facility Patient is admitted to hospital for treatment. Page B of Legal 2000 is completed.

33. Existing law defines “person with mental illness” as a person whose capacity to : 1. exercise self-control, judgment and discretion in the conduct of the person’s affairs 2. social relations or to care for his or her personal needs is diminished, as a result of mental illness, 3. to the extent that the person presents a clear and present danger of harm to himself or herself or others.

34. NOT INCLUDED: • Person in whom capacity is diminished by: • Epilepsy • Intellectual disability • Dementia • Delirium • Brief periods of intoxication: alcohol/drugs • Addiction to alcohol/drugs • Unless mental illness can be diagnosed. 

35. Reasonably inferred: • Without care, supervision, or continued assistance • Person will be unable satisfy their need for: • Nourishment • Personal or medical care • Shelter • Self protection or safety +

36. AND: There exists a reasonable probability person’s death, serious bodily injury or physical debilitation will occur within next 30 days Unless they are admitted

37. AND: Person presents a clear & present danger to others within preceding 30 days, IF Has inflicted or attempted to inflict serous bodily harm or made threats to inflict harm AND committed acts in furtherance of those threats.

38. This is an emergency power to be used only in extreme cases. • Because: • You are depriving a person of their freedom • You are labeling them as mentally ill

39. Military Veterans’ Suicides • It is reported by the V.A. that 22 vets commit suicide every day. • About 72% of veterans are at least 50 years old. • It is not surprising, then, that the VA found that people in this age group account for 69% of veteran suicides — or more than 15 of the 22 per day.

40. That means that 70% of vet suicides are not Afghanistan and Iraq vets. • The farther out from active duty a vet was the less likely the suicide was military related. They had problems just like the rest of us.

41. Video • Intervention of suicidal Navy Petty Officer

43. Video– Part 2

45. Bystander intervention • C P O reported it immediately • Had noticed oversleeping • Broke up with his girlfriend • Work habits decline • Lack of interest • Navy had program in place to evaluate quickly

46. If you encounter a military veteran on leave, recently discharged or retired years ago, consider notifying a military chaplain’s office.

47. Questions?