Suicide Prevention Training Psychological Services Section Miami-Dade Police Department

1. Suicide Prevention TrainingPsychological Services SectionMiami-Dade Police Department Dr. Scott W. Allen Police Psychologist

2. CLINICAL CORRELATES OF SUICIDE Legend: ++ Highly Correlated + Correlated 0 Not Correlated

3. THE 10 COMMONALITIES OF SUICIDE In previous publication (Shneidman 1985, 1990b) 1. The common purpose of suicide is to seek a solution 2. The common goal of suicide is cessation of consciousness 3. The common stimulus in suicide is intolerable psychological pain 4. The common stressor in suicide is frustrated psychological needs 5. The common emotion in suicide is hopelessness-helplessness 6. The common cognitive state in suicide is ambivalence 7. The common perpetual state in suicide is constriction 8. The common action in suicide is egression 9. The common interpersonal act in suicide is communication of intention 10.The common consistency in suicide is with lifelong coping patterns

4. SUICIDE RISK VARIABLES Relationship Potential • Absence or limited meaningful supportive relationships Suicide History • High lethality potential of attempt(s) • Presence of specific plan

5. SUICIDE RISK VARIABLES(Continued) Current Suicidal Ideation • Presence of specific plan • Accessibility of lethal means • Behavior suggestive of decision to die (e.g., severing relationships, giving away valued possessions; inappropriate sense of peace, calm or happiness; verbalizations regarding the utility of death) • Family history of suicide, especially parental suicide when patient between ages of 5-12

6. SUICIDE RISK VARIABLES(Continued) Psychiatric Medical Factors • Chronic psychiatric disorders • Recent discharge from psychiatric hospital (within 3 months) • Remission of psychiatric episode but continuance of secondary depression • Impulsivity (violence toward others and self, reckless driving, spending money) • Alcohol abuse • Drug abuse

7. DIFFERENCE BETWEEN SUICIDE ATTEMPTERSAND SUICIDE COMPLETERS

8. CHARACTERISTICS OF SUICIDE ATTEMPTERS Cognitive Style 1. Dichotomous (either-or) Thinking. 2. Rigid, inflexible cognitive style (things just are the way they are). 3. Inability to conceive if long term effects of actions. 4. Positive expectancies regarding the effectiveness of suicide as a solution to life problems. 5. Lack of insight; actions speak louder than words. 6 .Poor problem solving abilities (generates less possible solutions, prematurely rejects potentially viable alternatives, less active in problem solving behaviors). 7. Generalized feelings of hopelessness.

9. CHARACTERISTIC OF SUICIDE ATTEMPTERS(Continued) Affect Regulation 1. Tendency toward chronic feelings of anger, guilt, depression, anxiety, and boredom; 2. Inability to regulate emotional arousal in stressful situations (can’t turn off feelings); 4. Intense, unstable affect with rapid changes in nature of feelings.

10. CHARACTERISTIC OF SUICIDE ATTEMPTERS(Continued) Affect Tolerance 1. Belief that they “Can’t Stand” or tolerate negative affect. 2. Restrictive and negative beliefs about the place of negative feelings in the world. Bad feelings wrong. 3. Tendency toward impulsive attempts to get rid of affect (i.e., cutting, drinking, drug taking, binge eating).

11. Suicide is a Problem-Solving Behavior • Specifically, a complex set of behaviors aimed at: • improving an unpleasant situation (chronic depression) • ** preserving a threatened self-image (embarrassment and humiliation) • exercising omnipotence vs. helplessness (terminal illness/intractable pain) ** Most frequently occurring suicidal dynamic within law enforcement suicide

12. COGNITIVE DISTORTION: My feelings are wrong My thinking is correct Rational however confused and illogical thinking

13. Suicidal Paradox Suicide is a problem solving behavior, individuals become less anxious and symptomatic AFTER they have decided to kill themselves. Therefore, an actively suicidal individual will appear to be “back to themselves”. Thus, it is imperative to ask this person, “Are you better or have you decided to kill yourself?”.

14. Euphemism Euphemisms are “watered down” verbalizations of what a person is actually attempting to say. For example, a person may say, “You aren’t going to do anything stupid are you?”, or, “You aren’t going to hurt yourself, are you?”. A suicidal person (even if this person is your best friend) will manipulate this transaction by saying, “No”. The usage of the euphemism allows the suicidal person to avoid truthfully responding because the internal talk of the person is, “No, I’m not doing anything stupid, I have given this a lot of thought, and I’m killing myself.”, or, No, I’m not going to hurt myself, I’m going to blow my head off”.

15. INTERVENTION [Please Note: the following is actually the general content of what is suggested to be discussed in this section as each department will have their own specific policies and procedures within State laws and regulations]

16. It is imperative that the initial segment of this training include the Department’s operational perspective regarding the post- hospitalization phase of the police officer’s treatment. It is highly recommended that every department have either a written order or an accepted philosophical understanding that the hospitalization will be considered a medical crisis hospitalization and the police officer will not be at risk for losing his/her job solely predicated upon the hospitalization. The biggest barrier in the hospitalization process is the police officer’s fear (which is immediately validated by police officer peers attempting to assist the at-risk officer) that any hospitalization will eventually lead to termination from the department. INTERVENTION(Continued)

17. INTERVENTION(Continued) The actual first step in the intervention process is to understand that the number one risk factor for police suicide is embarrassment/humiliation. Therefore, early Identification of at-risk officers is crucial. Whenever an officer is arrested and/or relieved of duty (especially if there is media involvement), police officer peers, family members, or police psychologist staff should initiate a face-to-face assessment (always go to the potentially suicidal officer as opposed to agreeing to meet him/her somewhere) which would entail verbalizing the direct question (remember: no euphemisms),

18. INTERVENTION(Continued) “Are you considering or have you decided to kill yourself and what is your plan?”. If the response is, “Yes.”, then immediate voluntary crisis hospitalization is required. Further, if your department utilizes a staff or consulting psychologist, it is strongly suggested that they be utilized for the hospitalization process. This serves two purposes; first, the mental health professional can more quickly facilitate the actual hospitalization process, and the subsequent post-discharge follow-up process.

19. INTERVENTION(Continued) Second, as the saying goes, No good deed goes unpunished, it is recommended that police officer friends and peers of the at-risk officer do not actively facilitate the hospitalization process as this will eventually cause a significant shift in the interpersonal balance of power among the officers. Specifically, following discharge from the hospital, the affected officer will be able to cognitively appreciate that his friends and peers saved his life via the hospitalization. However, on an emotional level, the officer will again, experience a profound embarrassment and humiliation that he was hospitalized by his friends.

20. INTERVENTION(Continued) A final dynamic in the department’s attempt to lower the number of police suicides is the incorporation of a notification process whenever a police officer is arrested and/or relieved of duty. Typically, the Professional Compliance Bureau (Internal Affairs), the Domestic Crimes Bureau, or the Sexual Crimes Bureau are the entities which initiate and prosecute the arrest process, while individual districts facilitate the relief from duty process. Whenever either action occurs, the initiating entity is tasked with notifying the Psychological Services Section which then immediately responds to that entity and completes a suicidal assessment of the officer(s).

21. INTERVENTION(Continued) A further responsibility of the Psychological Services Section staff is to contact friends and/or family members to directly respond to the specific bureau/district or to the jail. This process ensures that family and friends will initiate direct contact with the at-risk officer which will significantly decrease the potential for that officer to attempt any self-destructive behaviors.