Impact of Suicide on Youth and Families

1. Impact of Suicide on Youth and Families The Ones We Miss

3. Video Who would have thought this could happen?

4. Why are YOU here today? Small group discussion: Introduce yourself What do you know about suicide? Share story with larger group if willing

5. What do we know? • Wisconsin – 5th highest in nation 10-14 year olds • Second leading cause of death – 15-24 yr. olds • National Rate = 8.76 • Wisconsin Rate = 10.78 • People who die in Wisconsin due to suicide are younger…

6. What else do we know? • Inpatient hospitalization for youth (15-24) is more than double than the nation. • However, E.R. visits are slightly lower than national rates What would this mean to you?

7. Learning Objectives • Gain understanding of the phenomenology of suicide and its impact on children and adolescents. • Understand the warning signs, risk factors, and protective factors of suicide when assessing children and families. • Gain understanding of the scope of the problem facing Wisconsin. • Develop an awareness and understanding of who are the “Ones We Miss”, including children in out-of-home care and youth who are bullied.

8. The Burden of Suicide in Wisconsin “Suicide affects an entire community and, because it is a complex issue, it will take a community to work on it.” Pat Derer, President, HOPES (Helping Others Prevent and Educate about Suicide)

9. The Burden of Suicide in Wisconsin • Firearms most frequently used method • 1 of 4 have history of previous attempts • Over 33% had alcohol present in their system • Mental health – especially depression • 4:1 male to female suicide deaths • Cost – years lost to society (20,000 years/year)

10. Interesting Data on WI • US rate declined 24% during 1995-2005 • Wisconsin only 8% decline • Firearms = 60% of completed youth suicides • But….88% hospitalizations for O.D. & cutting • So….most lethal methods = no hospitalization Rates of attempts, mortality, and self-reported risk among youth is unacceptably high

11. Who are we missing? Male deaths outnumber female deaths • use more lethal methods • are not hospitalized What else do we know about male adolescents?

12. Specific Risk for Males • Relationships • Access and ability to use lethal means • Murder – Suicide • Socially isolated • Family history • Mental illness or substance abuse • Divorce • Homosexuality

13. Risk Factors and Warning Signs Small group discussion: What do you know about: Risk factors? Warning signs? List on flip chart and post on wall when finished

14. Suicidal Behaviors • Suicide • Suicide Attempt • Suicide Ideation • Suicide Plans

15. Ones we miss….. • 55% talked about suicide within a month of their suicide • 45% did not • 73% who died DID NOT mention intent or ideation during last contact w/ a professional • Those who did: 60% - spouses 50% relatives 18% caregivers

16. Self-Injurious Behavior (SIB) • Severe • Stereotype • Socially Acceptable/ Emblematic • Superficial/Moderate

17. Children • Attempt suicide much younger than previously thought • Hanging is the most common method • Don’t express suicidal intent or signs of depression • Have conflicts with parents

18. Children Warning signs/Risk Factors: • Past attempts/threats • Past violent aggressive behavior • Cognitive immaturity/impulsivity • Little to no supervision • Bringing weapons to school • Recent experience of humiliation/shame • Bullying • Victim of abuse/neglect • Witnessing violence in the home • Themes of death/preoccupation with violence • Poor peer relationships • Vandalism, cruelty to animals, fire setting

19. Adolescents What separates those who attempt from those that think about it? • Substance abuse (12.8 times) • Enduring hopelessness • Isolation • Reluctance to discuss suicidal thoughts • Psychopathology

20. General Risk Factors for Adolescents • Previous suicide attempt • Mental Illness • Imitation • Family history of suicide • Sexual orientation • Sexual abuse • Other stressors • Incarceration

21. Protective Factors • Friends - most important protective factor • Supportive parent • School relationships

22. Are these… “Ones We Miss”? African American The System LGBTQ Native American Bullies Bullied Boys Boys

23. Girls • Ratio of attempts to completions: 4,000:1 • Suicide attempt is NOT a statistical risk factor • Depressive episode IS a risk factor • Do not always have a precipitating event • May attempt while recovering from depression • Panic attacks ARE a risk factor

24. Boys • Ratio of attempts to completions: 500:1 • Attempts ARE statistical risk factor • Often kill themselves within a few hours of a precipitating event: • Anxiety • Legal problems, relationships, humiliating experience, etc. • Aggressiveness IS a risk factor

25. Are these some of the “Ones We Miss”? African American The System LGBTQ Native American Native American Bullies Bullied Boys

26. Richard Cardinal

27. Possible Reasons for Increase • Stigma around mental health • Non-native workers • Removed from “community” • Historical oppression • Intergenerational trauma

28. Protective Factors • Culture • Tradition • Community • Family

29. Richard Cardinal • Risk Factors? • Protective Factors? • Commonalities to youth in the system today?

30. Are these some of the “Ones We Miss”? African American African Americans The System LGBTQ Native American Bullies Bullied Boys

31. African American Youth • Historically lower rates than whites • This is changing – 10-14 year olds greatest increase • Why? • Better knowledge, attention, reporting • Same as white counterparts • Structural barriers to health care • Attitudinal barriers • Economics/employment

32. African American Youth • Access to firearms • Isolation from social institutions • Protective factors: family, church, school, community

33. Are these some of the “Ones We Miss”? African American The System LGBTQ LGBTQ Native American Bullies Bullied Boys

34. LGBTQ Youth • Extremely high rate of depression, suicidal thoughts, and suicide attempts • 30% of all adolescent suicides • Primary cause (reported by LGBT teens) is negative family interactions • “One’s We Miss”…………….

36. Are these some of the “Ones We Miss”? African American The System LGBTQ Native American Bullies Bullies Bullied Bullied Boys

37. The Bullied and the Bullies Definition of Bullying: Unwantedaggressive behavior that is intentional and that involves an imbalance of power or strength. Typically repeated over time. Physical: hitting, tripping, breaking possessions Verbal: name calling, threatening, taunting Social/Relational: shunning, gossip/rumors, cyber bullying

38. Profile of a Bullied Child/Adolescent Two main groups: The Passive Victim The Provocative Victim LGBTQ Youth: Teens bullied 26 times/day 31% threatened or injured last year Impairs their education 2-4 times as likely to attempt suicide 28% drop out of school 4 of 5 say they don’t know ONE supportive person at school

39. Myths • Bullies are usually “loners” • They have low self-esteem • Bullying is the same as conflict • Most bullying is physical • It isn’t serious • Most likely to happen in urban school • Most likely to happen on the bus • Most kids who are bullied tell an adult. • Bullied kids learn to deal with it on their own.

40. Small Group Discussion Of children in your care (past or present)… • Which youth are “at risk”? • Identify specific risk factors • Identify protective factors

41. What can we do? The Question Model • Ask the question(s) • Listen and respond • Act or refer

42. Now, what do you do with what you know? large group discussion • Who do you have on your team? • Who makes the decision regarding the “act/refer”?

43. Whew! That is a lot of information! • Suicide in WI • Risk factors • Warning signs • Protective factors • The “ones we miss” • Special risks for children and youth in care • How to ask the questions

44. For the Bullied and Beautiful

45. The One Thing

46. Resources www.afsp.org (American Foundation for Suicide Prev.) www.sprc.org (Suicide Prev. Resource Center) www.mhawisconsin.org (Mental Health of WI) www.hopes-wi.org (Helping Others Prev. & Educate) www.suicidology.org www.suicidepreventionlifeline.org www.spanusa.org (Suicide Prev. ActionNetwork USA) www.nimh.nih.gov